Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia

Background: In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. Methods. A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions) on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender) were recruited through an online panel provider (participation rate: 10%) in 2010. Results: Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen) had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Conclusions: Medication-taking decisions are the subject of rational choices, influenced by the attributes of treatments and potentially amenable to intervention through education, strategic pricing and the altering of dosing characteristics. Understanding individual treatment preferences is thus an important step to improving adherence support provision in practice. Re-framing future interventions and policies to support rational and informed individual patient choices, is the way forward to realising the full potential health and economic benefits from the efficacious use of medications. © 2012 Laba et al.; licensee BioMed Central Ltd

Patient preferences for adherence to treatment for osteoarthritis: The MEdication Decisions in Osteoarthritis Study (MEDOS)

Background: Often affecting knee joints, osteoarthritis (OA) is the most common type of arthritis and by 2020 is predicted to become the fourth leading cause of disability globally. Without cure, medication management is symptomatic, mostly with simple analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), and glucosamine sulfate. Adherence to arthritis medications is generally low. Intentional non-adherence, that is deliberate decision-making about the use of analgesics, occurs in OA patients. To date, a limited number of studies have explored medication-taking decisions in people with OA nor the extent to which individuals' trade off one treatment factor for another in their decision-making using quantitative techniques. This study aimed to estimate the relative influence of medication-related factors and respondent characteristics on decisions to continue medications among people with symptomatic OA. Methods. A discrete choice experiment (DCE) was conducted among participants attending end-of-study visits in the Long-term Evaluation of Glucosamine Sulfate (LEGS) study (ClinicalTrials.gov ID: NCT00513422). The paper-based survey was used to estimate the relative importance of seven medication specific factors (pain efficacy, mode of action, dose frequency, treatment schedule, side effects, prescription, and out-of-pocket costs) and respondent characteristics on decisions to continue medications. Results: 188 (response rate 37%) completed surveys were returned. Four of the seven medication factors (side effects, out-of-pocket costs, mode of action, treatment schedule) had a significant effect on the choice to continue medication; patient characteristics did not. Assuming equivalent pain efficacy and disease-modifying properties for glucosamine, the positive relative likelihood of continuing with sustained-release acetaminophen was equivalent to glucosamine. By contrast, the negative relative likelihood of NSAID continuation was mostly driven by the side effect profile. The predicted probability of continuing with glucosamine decreased with increasing out-of-pocket costs. Conclusions: This study has characterised the complexity of medication-taking decisions that potentially underpin intentional non-adherent behaviour for people with symptomatic OA. In particular, medication risks and cost were important and ought to be borne into considerations in interpreting clinical trial evidence for practice. Ultimately addressing these factors may be the way forward to realising the full potential of health and economic benefits from the efficacious and safe use of OA medications. © 2013 Laba et al.; licensee BioMed Central Ltd

Implementasi peraturan daerah Kota Bandung nomor 16 tahun 2011 tentang pelayanan publik di Bus Trans Metro Bandung

Implementasi kebijakan pemerintah daerah merupakan salah satu hal terpenting dalam menjalankan pelayanan publik di masyarakat. Jika kebijakan yang sudah buat tidak diimplementasikan baik, maka tidak akan berdampak baik kepada masyarakat yang menjadi subjek dalam pelayanan apa yang diharapkan oleh masyarakat yang kesehariannya menggunakan pelayanan berupa transportasi bus TMB. Peneliti mendapatkan masalah berupa; di koridor IV jumlah, 10148 penumpang, jumlah bus TMB, ada 5. Di koridor III jumlah, 14856 penumpang, bus trans metro Bandung hanya 10. Di koridor II jumlah penumpang 28435 penumpang, penyediaan bus 10. Di koridor I jumlah penumpang 26356 penumpang, penyediaan bus hanya 15. Jumlah shelter secara keseluruhan berjumlah 104, dimana shelter yang masih dipergunakan ada 7, sedangkan yang rusak tapi masih digunakan berjumlah 97. Penelitian ini bertujuan untuk mengetahui bagaimana implementasi kebijakan Peraturan Daerah Kota Bandung Nomor 16 tahun 2011 tentang pelayanan publik di bus trans metro Bandung. Teori yang digunakan dalam penelitian implementasi kebijakan milik Daniel H. Mazmanian dan Paul A. Sabatier bahwa ada empat variabel yang mempengaruhi implementasi kebijakan; mudah atau tidaknya masalah yang digarap, tingkat dan ruang lingkup perubahan perilaku yang dikehendaki, kemampuan kebijakan menstruktur proses implementasi secara cepat implementasi, variabel-variabel di luar undang-undang yang mempengaruhi implementasi Penelitian ini menggunakan pendekatan kualitatif dengan jenis penelitian deskriptif. Sumber data dan jenis data dengan menggunakan data primer dan data sekunder. Teknik pengumpulan data dengan metode wawancara, observasi dan dokumentasi. Dengan metode analisis data secara deskriptif. Hasil dari penelitian secara keseluruhan dengan mengunakan teori yang dari Daniel H. Mazmanian dan Paul A. Sabatier dengan empat variabel, a. Mudah atau tidaknya masalah yang digarap. Selama mengimplementasikan kebijakan pasti ada masalah yang dihadapi selama memberikan pelayanan di bus TMB, tapi bisa diselesaikan, karena dipengaruhi oleh koordinasi dari penyelenggara dan pelaksana berjalan dengan mudah dan lancar. b. Tingkat dan ruang lingkup perubahan perilaku yang dikehendaki, dalam perumusan kebijakan pasti dan selalu ada perubahan perilaku yang dialami baik dari penyelenggara ataupun dari pelaksana. c. Kemampuan kebijkan mengstuktur proses bijkakan secara cepat, Selama mengimplementasikan dengan baik, dimana selama dalam memberi pelayanan ada juga kesalahan tapi bisa diatasi dengan baik dan dalam proses implementasi kebijakan koordinasi dari penyelenggara sampai ke pelaksana, mudah sehingga sudah dalam memberi pelayanan. d. Variabel-variabel diluar undang-undang yang mempengaruhi implementasi, dalam hal ini Pemerintah melakukan kerjasama dengan pihak swasta guna lajunya pelayanan publik

Representase Visi Surat Kabar dalam Foto Jurnalistik

Dewasa ini foto jurnalistik sebagai salah satu unsur penting dalam kegiatan jurnalistik modern, telah berkembang sangat pesat, apalagi sejak ditemukannya kamera digital yang menawarkan beraneka macam kemudahan. Fotografi jurnalistik semakin besar peranannya menjadi penyampai informasi kepada khalayak secara cepat dan akurat. Pada dasarnya semua foto yang dimuat di media massa diistilahkan sebagai foto jurnalistik, termasuk foto-foto peristiwa yang tampil di media online seperti internet. Artinya semua produk foto yang mempunyai nilai berita bisa disebut sebagai foto jurnalistik. Dalam konteks ini, fotografi jurnalistik tidak berdiri sendiri sebagai sebuah gambar, melainkan acapkali menjadi suatu kesatuan dengan berita. Keduanya saling mempengaruhi dan dipengaruhi, sehingga media massa cetak akan terasa hambar jika salah satunya tidak ada. Media massa cetak hanya akan menjadi lembaran-lembaran mati yang membosankan jika hadir tanpa foto atau gambar (Wijaya, 2011:21). Foto jurnalistik juga dapat dikatakan sebagai metode berkomunikasi melalui fotografi sehingga foto jurnalistik menjadi sebuah berita ataupun informasi yang dibutuhkan masyarakat baik lokal, regional, nasional maupun pada tingkat Internasional. Foto jurnalistik merupakan hasil jerih payah seorang fotografer jurnalistik (kerap juga disebut pewarta foto, foto jurnalis atau wartawan foto) yang dianggap dapat mengekspresikan sudut pandang sang fotografer namun pesan komunikasinya memiliki arti yang jauh lebih luas dari pada hanya sekedar arti dari sudut pandang sang fotografer. Foto jurnalistik merupakan salah satu produk jurnalistik yang dihasilkan oleh wartawan selain tulisan yang berbau berita (straight news atau hard news, berita bertafsir, berita kedalaman (depth reports) maupun non berita (artikel, feature, tajuk rencana, pojok, karikatur dan surat pembaca). Sebagai produk dalam pemberitaan, tentunya foto jurnalistik memiliki peran penting dalam media cetak maupun cyber media (internet). Penggunaan foto jurnalistik dalam surat kabar dan majalah mulai berkembang pada tahun 1930 an. Perkembangannya sangat cepat sehingga pada gilirannya teknologi foto dapat mendorong perkembangan media jurnalistik. Foto jurnalistik kemudian tumbuh menjadi suatu konsep dalam sistem komunikasi yang disebut dengan komunikasi foto (Photographic Communication). Bahkan komunikasi foto kini telah menempati kunci model dalam proses komunikasi massa. Sebagai suatu lambang yang berdimensi visual, foto dan gambar mendeskripsikan sesuatu pesan yang tidak secara eksplisit tertuang dalam komunikasi kata, baik lisan maupun tulisan (Muhtadi, 1999:101). Foto jurnalistik itu sendiri secara harfiah merupakan karya visual dari jurnalisme yang memilki nilai berita atau pesan yang layak untuk diketahui khalayak banyak dan disebarluaskan melalui media massa. Pertimbangan dari kelayakan sebuah foto jurnalistik meliputi unsur visi, informatif, kehangatan, faktual, relevan, misi termasuk juga di dalamnya mengenai angle atau sudut pengambilan gambar. Selain itu, salah satu prasyarat mutlak dari nilai sebuah foto jurnalistik adalah orisinalitas dan bukan hasil rekayasa termasuk rekayasa koputer grafis. Namun begitu, untuk kepentingan cover sebuah majalah atau media internet, pemakaian komputer grafis terhadap foto bisa ditolelir dan menjadi pertimbangan tersendiri dengan tujuan estetika untuk menarik pembaca

Evaluation de l’activité analgésique de l’extrait aqueux des feuilles de Mitracarpus scaber Zucc (Rubiacées), une plante médicinale de Côte d’Ivoire

Le recours constant et même grandissant par les populations économiquement faibles à la pharmacopée traditionnelle n’est plus discutable puisque de nombreuses recettes traditionnelles font et continuent de faire leurs preuves d’efficacité dans plusieurs pathologies comme le paludisme, les infections virales, le cancer, les infections bactériennes et fongiques. C’est dans ce but que notre équipe a étudié l’activité analgésique centrale et périphérique de l’extrait aqueux des feuilles de Mitracarpus scaber (EAMS) une plante utilisée en médecinetraditionnelle pour soulager des maux de tête et des douleurs des membres. Nous avons testé les concentrations suivantes : 10 mg/kg de poids corporel (PC); 1 mg/kg PC et 0,1 mg/kg PC du lyophilisat issu du macérât aqueux des feuilles de Mitracarpus scaber sur des souris de type Mus musculus par le test d’Amour et Smith et le writhing test à l’acide acétique. Les résultats obtenus montrent que l’extrait de feuilles de Mitracarpus scaber à la dose de 10 mg/kg PC possède d’une part une activité analgésique centrale comparable à celle de la morphine après administration aux souris, et d’autre part une activité analgésique périphérique supérieure à celle du ketoprofène dosé à 10 mg/kg PC. Nos résultats confirment l’utilisation traditionnelle des feuilles deMitracarpus scaber comme analgésique. © 2010 International Formulae Group. All rights reservedMots clés : Extrait de plante, douleur, souris

The household economic burden of eating disorders and adherence to treatment in Australia

© 2014 Gatt et al.; licensee BioMed Central Ltd. Background: This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. Methods: Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence. Results: The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health. Conclusions: This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families

PERSPECTIVES OF DEVELOPMENT OF ORGANIC FARMING IN LVIV REGION

Стаття присвячена аналізу стану органічного виробництва, динаміки основних показників розвитку органічного виро-бництва в Україні. Інтенсифікація сільського господарства, яка останнім часом відбувається в усьому світі, має негативний вплив не лише на навколишнє середовище, але і виснажує природні ресурси, без яких ведення агровиробництва неможливе. До переваг органічного сільського господарства можна віднести отримання якісної екологічно чистої продукції, формува¬ння стійких агроекосистем, порівнюючи із традиційними. Незважаючи на декларовані у законодавстві плани розширення органічного виробництва в Україні, таке виробництво зростає повільно, а більша частина виробленої продукції йде на експорт. В умо-вах Львівської області передумовами розвитку органічного сільського господарства є: потреба відтворення родючості грунтів та збереження довкілля; піднесення рівня життя й розвитку сільських територій; потреба забезпечення ринку здоровою, якісною продукцією; необхідність покращення іміджу регіону як виробника екологічної продукції. Як результат, органічне виробництво може стати ефективним інструментом збереження традиційних знань ведення господарства у кожному регіоні, а також зменшення міграції сільського населення до мегаполісів. Проведений аналіз дав можливість ідентифікувати основні проблеми більш динамічного розвитку органічного вироб-ництва України та запропонувати шляхи їх усунення. Визначено перспективи розвитку ринку органічної продукції на основі його поточного стану, тенденцій розвитку та чинників, що на нього впливають.Интенсификация сельского хозяйства, происходящая в последнее время во всем мире, негативно влияет не только на окружающую среду, но и истощает природные ресурсы, без которых невозможно ведение агропроизводства. К преимуществам органического сельского хозяйства можно отнести получение качественной экологически чистой продукции, формирование устойчивых агроекосистем, в сравнении с традиционными. Несмотря на декларируемые в законодательстве планы расширения органического производства в Украине, такое производство растет медленно, а большая часть произведенной продукции идет на экспорт. В условиях Львовской области предпосылками для развития органического сельского хозяйства являются: необходимость восстановления плодородия почв и сохранения окружающей среды; повышение уровня жизни и развития сельских территорий; потребность обеспечения рынка здоровой, качественной продукцией; необходимость улучшения имиджа региона как производителя экологической продукции. Как результат, органическое производство может стать эффективным инструментом сохранения традиционных знаний ведения хозяйства в каждом регионе, а также уменьшение миграции сельского населения в мегаполисы. Проведенный анализ позволил идентифицировать основные проблемы более динамичного развития органического производства Украины и предложить пути их устранения. Определены перспективы развития рынка органической продукции на основании его текущего состояния, тенденций развития и факторов, влияющих на него.The article is devoted to the analyses of organic production which has a range of economical and ecological benefits. We analyzed the dynamics of the main indicators of the development of organic production in Ukraine. Intensification of agriculture that has been going on in the world, has a negative impact not only on the environment but also depletes natural resources without driving agricultural production impossible. The advantages of organic farming are: hight quality eco-friendly products, formation of stable agricultural ecosystems, higher than traditional productivity, less energy spending. In spite of declared legislation plan to expand organic production in Ukraine, production is increasing very slowly, and most of the output is getting exported. The prerequisites for the development of organic agriculture in the Lviv region are: the necessity of soil fertility restoration and preservation of the envi-ronment; the rise of living standards and rural development; the necessity to ensure market healthy, quality products; the necessity to improve the image of the region as a producer of environmentally friendly products. As a result, organic farming can be an effective tool for preserving traditional knowledge of farming in each region and to reduce migration of rural population to the cities. The analysis enables us to identify the main problems of organic production in Ukraine and introduce the ways to solve them. Author researches the market prospects of organic products based on its current status, trends and factors which are affecting it

Participant preferences for an aboriginal-specific fall prevention program: Measuring the value of culturally-appropriate care

© 2018 Angell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Culturally-specific services are central to efforts to improve the health of Aboriginal Australians. Few empirical studies have demonstrated the value of such services relative to mainstream alternatives. Objective To assess the preferences and willingness to pay (WTP) of participants for attending a class and the relative importance of transport, cost and cultural-appropriateness in the choices made by participants. Design A discrete choice experiment (DCE) was conducted alongside a study of a culturally-specific fall-prevention service. Attributes that were assessed were out-of-pocket costs, whether transport was provided and whether the class was Aboriginal-specific. Choices of participants were modelled using panel-mixed logit methods. Results 60 patients completed the DCE. Attending a service was strongly preferred over no service (selected 99% of the time). Assuming equivalent efficacy of fall-prevention programs, participants indicated a preference for services that were culturally-specific (OR 1.25 95% CI: 1.00–1.55) and incurred lower out-of-pocket participant costs (OR 1.19 95% CI 1.11–1.27). The provision of transport did not have a statistically significant influence on service choice (p = 0.57). Discussion and conclusions This represents the first published DCE in the health field examining preferences amongst an Aboriginal population. The results empirically demonstrate the value of the culturally-specific element of a program has to this cohort and the potential that stated-preference methods can have in incorporating the preferences of Aboriginal Australians and valuing cultural components of health services. Note on terminology As the majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (97.2%), this population will be referred to as ‘Aboriginal’ in this manuscript

Examining the use of process evaluations of randomised controlled trials of complex interventions addressing chronic disease in primary health care-a systematic review protocol

© 2016 The Author(s). Background: Randomised controlled trials (RCTs) of complex interventions in primary health care (PHC) are needed to provide evidence-based programmes to achieve the Declaration of Alma Ata goal of making PHC equitable, accessible and universal and to effectively address the rising burden from chronic disease. Process evaluations of these RCTs can provide insight into the causal mechanisms of complex interventions, the contextual factors, and inform as to whether an intervention is ineffective due to implementation failure or failure of the intervention itself. To build on this emerging body of work, we aim to consolidate the methodology and methods from process evaluations of complex interventions in PHC and their findings of facilitators and barriers to intervention implementation in this important area of health service delivery. Methods: Systematic review of process evaluations of randomised controlled trials of complex interventions which address prevalent major chronic diseases in PHC settings. Published process evaluations of RCTs will be identified through database and clinical trial registry searches and contact with authors. Data from each study will be extracted by two reviewers using standardised forms. Data extracted include descriptive items about (1) the RCT, (2) about the process evaluations (such as methods, theories, risk of bias, analysis of process and outcome data, strengths and limitations) and (3) any stated barriers and facilitators to conducting complex interventions. A narrative synthesis of the findings will be presented. Discussion: Process evaluation findings are valuable in determining whether a complex intervention should be scaled up or modified for other contexts. Publishing this protocol serves to encourage transparency in the reporting of our synthesis of current literature on how process evaluations have been conducted thus far and a deeper understanding of potential challenges and solutions to aid in the implementation of effective interventions in PHC beyond the research setting. Systematic review registration: PROSPERO CRD42016035572

Rapid and substantial increases in anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants

© 2018 Morgan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objectives To quantify changes in anticoagulant use in Australia since the introduction of Non-vitamin K antagonist anticoagulants (NOACs) and to estimate government expenditure. Design Interrupted-time-series analysis quantifying anticoagulant dispensing, before and after first Pharmaceutical Benefits Scheme (PBS) NOAC listing in August 2009 for venous thromboembolism prevention; and expanded listing for stroke prevention in non-valvular atrial fibrillation (AF) in August 2013, up to June 2016. Estimated government expenditure on PBS-listed anticoagulants. Setting and participants PBS dispensing in 10% random sample of Australians, restricted to continuous concessional beneficiaries dispensed oral anticoagulants from July 2005 to June 2016. Total PBS anticoagulant expenditure was calculated using Medicare Australia statistics. Main outcome measures Monthly dispensing and initiation of oral anticoagulants (warfarin, rivaroxaban, dabigatran or apixaban). Annual PBS anticoagulant expenditure. Results An estimated 149,180 concessional beneficiaries were dispensed anticoagulants (100% warfarin) during July 2005. This increased to 292,550 during June 2016, of whom 47.0%, 27.1%, 18.7% and 7.2% were dispensed warfarin, rivaroxaban, apixaban and dabigatran, respectively. Of 16,500 initiated on anticoagulants in June 2016, 24.3%, 38.2%, 30.0% and 7.5% were initiated on warfarin, rivaroxaban, apixaban, and dabigatran, respectively. Compared to July 2005-July 2013, from August 2013-June 2016, dispensings for all anticoagulants increased by 2,303 dispensings/month (p<0.001, 95%CI = [1,229 3,376]); warfarin dispensing decreased by 1,803 dispensings/month (p<0.001, 95%CI = [–2,606, –1,000]). Total PBS anticoagulant expenditure was $19.5 million (97.0$203.3 million (86.2% concessional) in 2015/16, of which 11.2% was warfarin. Conclusions The introduction of the NOACs led to substantial increases in anticoagulant use and expenditure in Australia