Unintentional non-adherence and belief in medicines in older adults

Objective

To determine whether beliefs in medicines are associated with forgetfulness and carelessness in taking medications.

Methods

Using a survey research design, baseline data (N = 1220) and follow-up data (N = 1024) were collected through an Internet survey using a convenience sample from Medicare enrollees aged 65 and older and who were Internet users. Logistic regression models were used to determine if patient's beliefs about the necessity of taking prescribed medications and their concern beliefs regarding the potential consequences of taking medications were significant in predicting forgetfulness and carelessness in taking medications.

Results

Concern beliefs in medicines were a significant predictor of forgetfulness and carelessness in taking medications.

Conclusion

If all cases of forgetfulness and carelessness in taking medications are considered as unintentional non-adherence with no reference to the patient's beliefs in medicines; using cue based interventions such as phone reminders or alarms are not likely to reduce non-adherence. There was a strong association between patient belief in medications and non-adherence in older adults who were Medicare enrollees.

Practical implications

It is important that researchers consider the influence that patient medication beliefs have on patient adherence to develop better interventions to reduce non-adherence.     

Role of appetite-regulating peptides in alcohol craving: an analysis in respect to subtypes and different consumption patterns in alcoholism

BACKGROUND: A role of appetite-regulating peptides like leptin and ghrelin in the neurobiology of alcohol craving has been proposed by several studies. Aim of this analysis was to search for differences regarding an association between these peptides and alcohol craving with respect to different subtypes and beverage consumption patterns in patients with alcohol dependence. METHODS: We analyzed a sample of 188 patients at admission for alcohol detoxification regarding leptin and ghrelin (n=117) serum levels. Craving was measured using the Obsessive Compulsive Drinking Scale (OCDS). Patients were classified according to Lesch's typology of alcohol dependence and according to their preferred type of alcoholic beverage (beer, wine, spirits). RESULTS: Using general linear models to analyze a possible interaction between subtypes and leptin/ghrelin levels with respect to craving, we found a significant positive association for leptin in patients of Lesch's types 1 and 2, and in patients consuming beer or wine. Ghrelin levels showed a significant trend regarding an association with craving in patients of Lesch's type 1. In the other subgroups we found no significant results. CONCLUSIONS: Our findings show that appetite-regulating peptides may be of special importance regarding alcohol craving in subtypes of patients. This may explicate at least in part previous contradictory findings.     

Herp mRNA expression in patients classified according to Lesch's typology

Chronic alcoholism is associated with hyperhomocysteinemia. Herp (homocysteine-induced endoplasmic reticulum [ER] protein) levels are elevated as a response to ER stress prior to mitochondrial dysfunction and cell death. The Lesch classification system has been applied in many studies and has been found useful. This study was undertaken to assess Herp mRNA expression in actively drinking patients with alcoholism who were classified according to Lesch's typology. Herp mRNA expression levels were measured by quantitative PCR in the blood of 76 male alcoholic patients. Patients were classified according to Lesch's typology (type I-IV). With respect to Lesch's typology, a significant difference in Herp mRNA expression regarding the four subtypes could be shown (F[3,72] = 2.83, P = .044). In a logistic regression model (dependent variable Herp dichotomized by a median-split; adjusted for age and homocysteine levels) the subtype II differed statistically significant from the others (odds ratio, 5.75; 95% confidence interval, 2.07-15.98; P = .001). Type II alcoholic patients had a statistically significant higher expression of Herp mRNA due to upregulation of the expression of this neuroprotective cell non-chaperone by toxic effects of ethanol. These findings might explain why type II patients do not express severe withdrawal symptomatology (i.e., withdrawal seizures). These findings may be useful in the understanding and treatment considerations of different subtypes of alcohol dependence.     

Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters

Objective

To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis.

Neighborhood environment profiles related to physical activity and weight status: a latent profile analysis

Background

Neighborhood built environments (BE) include combinations of co-existing stimuli influencing physical activity (PA). Dealing with numerous environmental variables and complexity presents a significant challenge. The current analysis explored whether a range of reported BE features associated with adults' physical activity produced distinct multivariate patterns, and tested whether adults' PA and body mass differed by BE profiles.

Methods

Participants (20-65 years, 48.2% female, 26% ethnic minority) were recruited between 2002 and 2005 from 32 neighborhoods from Seattle-King County, WA (N = 1287) and Baltimore, MD-Washington, DC regions (N = 912). Independent Latent Profile Analyses were conducted in each region with 11 environmental variables from the Neighborhood Environment Walkability Scale. Validity of the neighborhood profiles was examined by their relationship to PA (accelerometer-derived moderate-to-vigorous minutes/day, self-reported minutes/week of walking for transportation and leisure) and self-reported BMI using ANCOVA models.

Results

Neighborhood profiles for Seattle and Baltimore regions were visually similar, suggesting generalizability. High-walkable recreationally-dense neighborhoods differed significantly from other neighborhood types by as much as 13 MVPA minutes/day, almost 60 minutes/week of walking for transportation, and 75 min/week of leisure-time activity. Neighborhood profiles also differed significantly for BMI.

Discussion

These findings could help identify optimal patterns of environmental attributes that facilitate physical activity and improve weight status.