Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8)

BackgroundPreconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy. MethodsThis cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use. ResultsOf the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P \u3c 0.001) and perceived knowledge (p \u3c 0.001). After controlling for other factors, self-efficacy (b = .37) and perceived knowledge (b = .09) remained associated with OCP adherence. ConclusionLess than 20% of respondents met the criteria for high adherence to OCPs. Self-efficacy and knowledge were associated with higher OCP adherence. Targeted interventions from healthcare providers, health educators, and other adherence related media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs

Filling gaps in seed germination and species selection: work in progress for dryland restoration in Argentina

Los practicantes de la restauración y rehabilitación ecológica (RRE) carecen de información completa sobre los tratamientos pregerminativos más efectivos para promover la germinación de plantas nativas de regiones áridas y semiáridas, y sobre la supervivencia y crecimiento de estas especies a campo. Aquí informamos resultados del enfoque “estrategias profesionales inteligentes” para evaluar la germinación de especies del Monte Austral, una región árida del sur de Argentina. Nuestros objetivos fueron probar una pequeña cantidad de tratamientos pregerminativos que son efectivos en otras regiones áridas y evaluar los resultados de germinación de 16 especies en comparación con la información existente sobre su desempeño a campo. Este enfoque demostró ser altamente efectivo dado que, de las 16 especies de arbustos evaluadas, 11 mostraron tasas de germinación adecuadas para RRE (es decir, más del 50%). Solo cuatro especies alcanzaron altas tasas de supervivencia y altos valores de cobertura vegetal en las plantaciones, y otras cuatro mostraron altas tasas de supervivencia, pero la cobertura vegetal fue baja o no se evaluó. Argumentamos que sería estratégico adoptar este modelo, que incluye obtener y comparar información sobre la germinación de semillas y el desempeño de las mismas especies a campo, para la selección de especies en RRE.Ecological restoration and rehabilitation (ERR) practitioners lack comprehensive information on the most effective seed dormancy alleviation treatments to enhance germination of native plants from arid and semiarid regions, as well as on survival and growth rates of these species in the field. In this paper we report on the results of a “professional intelligent tinkering” approach to assess seed germination of species from the Monte Austral, an arid region in southern Argentina. We aim to test a small number of seed dormancy alleviation treatments reported to be effective in other arid regions, and to assess germination results for 16 species against existing information on their performance in the field. This approach proved to be highly effective given that, out of the 16 shrub species evaluated, 11 showed germination rates suitable for ERR (i.e., over 50%). Only four species attained both high survival rates and plant cover values in outplantings, while four other species showed high survival rates but their plant cover values were low or not assessed. We argue that this approach, which involves obtaining and comparing data on seed germination rate with performance of the same species in the field, would be strategic for species selection in ERR.Fil: Rodriguez Araujo, María Emilia. Universidad Nacional del Comahue. Facultad de Ciencias del Ambiente y la Salud. Laboratorio de Rehabilitación y Restauración de Ecosistemas Áridos y Semiáridos Degradados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Confluencia; ArgentinaFil: Pérez, Daniel Roberto. Universidad Nacional del Comahue. Facultad de Ciencias del Ambiente y la Salud. Laboratorio de Rehabilitación y Restauración de Ecosistemas Áridos y Semiáridos Degradados; ArgentinaFil: Aronson, James. Missouri Botanical Garden; Estados Unidos. Ecohealth Network; Estados UnidosFil: Cross, Adam T.. Ecohealth Network; Estados Unidos. Curtin University; Australi

Engaging National Guard and Reserve Families in Research

This study’s goal was to identify how to increase National Guard and Reserve military family participation in research. Compared to Active Duty, families of National Guard and Reserve members are more geographically dispersed and less connected to a military base which can prove problematic for research recruitment and participation. We conducted a focus group study with Service Members and spouses (N = 14) to ascertain their perspectives on (a) whether National Guard and Reserve families would be interested in participating in research studies, (b) potential effective strategies for recruitment, (c) ideal data collection procedures, and (d) how to retain these families in longitudinal studies. Information provided in the focus groups was assessed using open and axial coding for themes. The majority of participants indicated that National Guard and Reserve families would be interested and willing to participate in research. Participants delineated several perceived participation barriers, however. The most-cited obstacles were time constraints and limited proximity to research study locations. Service Members and spouses were unanimous in their noted preference for internet surveys and indicated that researchers need to build relationships with potential participants, particularly if they intend to retain military families in longitudinal studies

A framework for understanding sources of bias in medication adherence research

The sources of bias in medication adherence research have not been comprehensively explored. We aimed to identify biases expected to affect adherence research and to develop a framework for mapping these onto the phases of adherence (initiation, implementation and discontinuation). A literature search was conducted, key papers were reviewed and a Catalogue of Bias was consulted. The specific biases related to adherence measurement and metrics were mapped onto the phases of adherence using a tabular matrix. Twenty-three biases were identified, of which 11 were specifically relevant to adherence measures and metrics. The mapping framework showed differences in the numbers and types of biases associated with each measure and metric while highlighting those common to many adherence study designs (e.g., unacceptability bias and apprehension bias). The framework will inform the design of adherence studies and the development of risk of bias tools for adherence research.<br/

Restoring natural capital: without reserves, no goods and no services

Una de las ideas más innovadoras y atractivas que se están acuñando en la actualidad está relacionada con la necesidad que tiene la humanidad de preservar y manejar los recursos naturales - o capital natural - remanente e invertir en la restauración del capital natural (RCN) degradado para reincorporarlo a la cadena de bienes y servicios que la sociedad requiere. En este artículo, presentamos definiciones y conceptos básicos, para mostrar como la RCN es un enfoque más amplio en relación al propuesto en la restauración ecológica de ecosistemas naturales. Damos a conocer estudios de caso, como ejemplos del enfoque de la RCN, y su impacto sobre el suministro de bienes y servicios en Argentina, Colombia, México y Chile. Terminamos con una breve discusión y algunas recomendaciones para la investigación y el desarrollo de la RCN a nivel local, regional y global.One of the most innovative and attractive ideas to emerge in recent years is the call for humanity to preserve and manage what remains of our natural resources, or natural capital, and to invest in the restoration of degraded natural capital (RNC), in order to replenish the reserves which assure the flows of natural goods and services that society requires. In this paper, we present definitions and basic concepts to show that RNC is a broader approach than that of the ecological restoration of degraded ecosystems. We present case studies from Argentina, Colombia, Mexico and Chile explaining in each case the RNC approach and the impact on ecosystem services. We conclude with a brief discussion and some recommendations for research and development of RNC at local, regional and global scales

Predictors of Congruency between Self-reported Hypertension Status and Measured Blood Pressure in the Stroke Belt

Background: Few studies have comprehensively investigated the validity of self-reported hypertension (HTN) and assessed predictors of HTN status in the stroke belt. This study evaluates validity self-reporting as a tool to screen large study populations and determine predictors of congruency between self-reported HTN and clinical measures. Methods: Community Initiative to Eliminate Stroke project (n = 16,598) was conducted in two counties of North Carolina in 2004 to 2007, which included collection of self-reported data and clinical data of stroke-related risk factors. Congruency between self-reported HTN status and clinical measures was based on epidemiological parameters of sensitivity, specificity, and predictive values. McNemar’s test and Kappa agreement levels assessed differences in congruency, while odds ratios and logistic regression determined significant predictors of congruency. Results: Sensitivity of self-reported HTN was low (33.3%), but specificity was high (89.5%). Prevalence of self-reported HTN was 16.15%. Kappa agreement between self-report and clinical measures for blood pressure was fair (k = 0.25). Females, whites, and young adults were most likely to be positively congruent, whereas individuals in high risk categories for total blood cholesterol, low density lipoproteins, triglycerides, and diabetes were least likely to accurately capture their HTN status. Conclusion: Self-report HTN information should be used with caution as an epidemiological investigation tool

Ethnic and Racial Differences of Baseline Stroke Knowledge in a “Stroke Belt” Community

Acute stroke is often a treatable condition; however, intervention is time dependent and typically should ensue within 3 hr from onset of symptoms. The ability of individuals to understand stroke risk factors to reduce individual risk and to recognize warning signs and symptoms of stroke as signals to initiate medical care is paramount to decreasing stroke-related morbidity and mortality. This descriptive study presents ethnic and racial differences of baseline stroke knowledge among residents (n = 1,904) of two North Carolina counties situated in the Stroke Belt. Findings suggest a global stroke knowledge deficit that is more pronounced among Hispanics. Future community stroke education campaigns need to consider various educational mediums and outlets to ensure inclusion of persons at highest risk for stroke. Suggestions are provided for possible content of future stroke knowledge and prevention campaign

Predictors of Uncontrolled Hypertension in the Stroke Belt

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self-reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN