Accountability in reminder-based adherence interventions: A review

ObjectiveInterventions to elicit accountability capitalize on social behaviors to improve adherence but are distinct from reminders. However, little is known about the impact of accountability in reminder-based adherence interventions. Through a literature review, we aim to identify the frequency and effectiveness of accountability in reminder-based intervention studies.MethodsPubMed and PsycArticles were searched for reminder-based adherence studies. Articles were categorized as reminder-only or reminder with accountability studies. Studies were characterized by outcome measures, and differences between control and intervention groups were compared for studies that used electronic monitoring devices.Results165 studies met the inclusion criteria; 154 used reminders without accountability (93%). 79 of the 154 reminder-only studies (51%) improved adherence in intervention groups compared to controls. Eleven of the 165 studies (6.6%) included an accountability aspect. The intervention group had better adherence than controls in 10 out of the 11 reminder with accountability studies (91%).ConclusionsAlthough distinct from reminders, accountability can be incorporated in reminder-based interventions. However, it is not commonly included in reminder-based interventions.Practice implicationsIt is important to consider accountability’s effects on encouraging patient medication adherence. The addition of accountability interventions may further boost adherence, but few studies currently incorporate these types of interventions.     

基于计划行为理论的孕妇关于婴儿睡眠安全行为意向影响因素研究

目的 探究孕妇关于婴儿睡眠安全实践意向的影响因素。方法 本研究采用方便抽样选取青岛市某三甲医院四个院区来院孕检的孕妇，使用基于计划行为理论的自编问卷，调查其对于婴儿睡眠安全的行为态度、主观规范、知觉行为控制及行为意向，应用多元线性回归分析其行为意向的影响因素。结果 孕妇对于婴儿睡眠安全的行为态度、主观规范、知觉行为控制及行为意向得分分别为(22.26±5.27)、(16.65±4.17)、(13.35±4.23)、(20.77±5.62)分。是否为独生子女(t = - 3.555, P＜0.001)，年龄(F = 3.764, P = 0.011)、文化程度(F = 5.983, P＜0.001)、居住地(F = 5.865, P = 0.003)和家庭人均月收入(F = 8.485, P＜0.001)不同的孕妇关于婴儿睡眠安全的行为意向有统计学差异。多元线性回归分析结果示文化程度(β = 0.655, t = 3.659, P＜0.001)、是否为独生子女(β = 1.214, t = 3.131, P = 0.002)、行为态度(β = 0.373, t = 9.598, P＜0.001)、主观规范(β = 0.328, t = 6.426, P＜0.001)及知觉行为控制(β = 0.231, t = 5.371, P＜0.001)是行为意向的主要影响因素。结论 孕妇对于婴儿睡眠安全实践的认知及行为意向较积极，但其知觉行为控制力有待提高。孕期健康教育应增加婴儿睡眠安全内容，提高孕妇对其认知及自我效能感，展开公众教育以增强孕妇的社会支持，改善其与婴儿睡眠有关的养育行为。     

Development of a new tool for predicting the behavior of individuals with intellectual disability in the dental office: A pilot study

BackgroundThe dental treatment of individuals with intellectual disability can represent a considerable professional challenge.ObjectiveTo develop a model for predicting the behavior of patients with intellectual disability in the dental office.MethodsThe study group comprised 250 patients with Down syndrome (DS), autism spectrum disorder (ASD), cerebral palsy (CP), idiopathic cognitive impairment or rare disorders. We collected their demographic, medical, social and behavioral information and identified potential predictors (chi-squared test). We developed stratified models (Akaike information criterion) to anticipate the patients'behavior during intraoral examinations and to discern whether the dental treatment should be performed under general anesthesia. These models were validated in a new study group consisting of 80 patients. Goodness of fit was quantified with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC). We developed a mathematical algorithm for executing the models and developed software for its practical implementation (PREdictors of BEhavior in Dentistry, “PREBED”).ResultsFor patients with DS, ASD and CP, the model predicting the need for physical restraint during examination achieved a PPV of 0.90, 0.85 and 1.00, respectively, and an NPV of 0.66, 0.76 and 1.00, respectively. The model predicting the need for performing treatment under general anesthesia achieved a PPV of 0.63, 1.00 and 1.00, respectively, and an NPV of 1.00, 1.00 and 0.73, respectively. However, when validating the stratified models, the percentage of poorly classified individuals (false negatives + false positives) ranged from 24% to 46.6%.ConclusionsThe results of the PREBED tool open the door to establishing new models implementing other potentially predictive variables.     

Neurophysiological evaluation of visual function in iRBD: potential role in stratifying RBD conversion risk

Study objectivesTo evaluate neurophysiological alterations of visual function in idiopathic REM sleep Behavior Disorder (iRBD) both as markers and predictors of neurodegenerative disorders.MethodsIn a longitudinal follow-up study of 46 consecutive iRBD patients (follow-up duration 8.4 ± 3.4 years), the baseline parameters in luminance-contrast pattern (VEPp), red-green color (VEPc) and motion-onset (VEPm) Visual Evoked Potentials in iRBD were compared to early (ePD) and advanced (aPD) Parkinson's Disease subjects. Parameters of latency and amplitude of iRBD converters to neurodegenerative disease were compared with those of the non-converters.ResultsThe VEP P100 mean latency values for both eyes and for both stimulation checks (30′ and 15’) were significantly longer in all the three groups of patients as compared to controls; moreover latencies were longer in aPD than in the iRBD group who did not differ from the ePD group. The same held true when we analyzed the number of abnormal subjects belonging to each diagnostic group with a higher number of abnormal subjects in the aPD group compared to both the ePD and in iRBD groups. Chromatic and motion potentials were not different from controls and did not differ in the 3 diagnostic groups. The iRBD subjects who converted to a neurodegenerative disorder showed longer P100 latencies and a higher occurrence of VEPp abnormalities than those who did not convert. Again chromatic and motion VEPs were not different depending on conversion.ConclusionsIn iRBD patients the detection of an abnormal VEPp should be considered as a red flag for possible synnucleinopathy, eventually contributing in stratifying the risk of phenoconversion.     

Normative values of the motor competence assessment (MCA) from 3 to 23 years of age

ObjectivesGrowing evidence of the importance of motor competence for developing a healthy lifestyle has been established in the last decade. Nonetheless, no single instrument or observation tool have been able to fully measure this construct, particularly because most were built for the diagnosis of children in risk for motor impairment; are limited to a few years of the developmental span; lack objectivity in the assessment protocols; or do not include the locomotor, stability, and manipulative components. This led to the difficulty of comparing researches, and longitudinally follow children into adulthood. Recently, a novel proposal to assess motor competence was presented - the Motor Competence Assessment (MCA) - and this study aims to present the MCA normative data from 3-to-23 years.Design and methodsTwo thousand and eighty-seven participants (1102 boys) between 3 and 23 years of age were evaluated in the MCA (standing long jump, 10 m shuttle run, throwing velocity, kicking velocity, lateral jumps, shifting platforms). Results for each test were introduced in the LMS Chartmaker 2.3. The best model for test and sex was used, resulting in normative curves and percentile values.ResultsFinal norms showed a good fit to the instrument developmental expectations, allowing to differentiate and classify performances along the age interval.ConclusionsThe MCA age- and sex- normative values allow to assess motor competence from childhood to early adulthood. Future directions will include obtaining a total MCA score and the normative scores for the MCA components (stability, locomotion, object control), and to expand the norms to adulthood and old age.     

Une approche évolutionniste de la manie dans une perspective transculturelle

IntroductionThe objective of this paper is to verify if traits and symptoms defined as pathological and maladjusted in certain contexts may produce adaptive effects in other contexts, especially if they occur in sub-threshold forms.MethodsA historical examination of how the symptoms of depression have changed in front of great social changes and an analysis of Sardinian migrants’ thymic profiles toward several metropolises.Results and conclusionsMood disorders have been increasing since the “English malady” in the 17th century, and we suppose that some forms of mood disorders might have an adaptive advantage. Otherwise, the increase of such an epidemic would have been self-limited. From a sociobiological point of view, it is highly probable that the environment of a rapidly evolving society can select people who are explorers and able to support accelerated biorhythms and that the condition of social change stimulates psychological and psychopathologic changes. It is also possible that hyperthymic persons modulate and create the new environment. If this model can explain the epidemic of mood disorders, its verification should guide future research.     

火针膝周密刺对膝关节骨性关节炎鼠关节形态及软骨LOXL2的影响

目的:探讨火针膝周密刺对膝关节骨性关节炎(Knee Osteoarthritis,KOA)大鼠行为学、关节形态及软骨中赖氨酰氧化酶相关蛋白2(LOXL2)影响性。方法:选择30只健康雄性大鼠,10只作为对照不作任何处理。20只大鼠建立KOA模型,成模后随机分成2组,分别予普通针刺和火针膝周密刺,1次/3 d,连续6次。观察各组大鼠Leauesne MG评分、关节软骨细胞情况,外周血及关节软骨转化生长因子-β1(TGF-β1)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶3(MMP-3)、LOXL2水平变化。结果:治疗后火针组Leauesne MG评分中的局部疼痛刺激反应、步态、关节活动范围、关节肿胀度较对照组、模型组差异有统计学意义(P<0.05)。血清及关节软骨MMP-3、TGF-β1、TNF-α含量水平显著低于模型组(P<0.05),LOXL2显著高于模型组(P<0.05)。火针组电镜下软骨细胞形状规则、细胞核完整且饱满,微绒毛少量存在,内质网丰富,有散在的染色质。结论:火针膝周密刺能减轻K0A关节软骨损伤,降低炎性反应,改善软骨LOXL2水平,这可能是火针治疗KOA一个作用机制。