Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies

© 2017 The Author (s). This is an Open Access article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.BACKGROUND: Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence. PURPOSE: The aim of this study was to identify psychological determinants that most influence stroke survivors' medication adherence. METHODS: In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953-2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF. RESULTS: Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions ('Emotions' domain) such as anxiety and concerns about medications ('Beliefs about Consequences' domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications ('Knowledge' domain) and stronger beliefs about medication necessity ('Beliefs about Consequences' domain). Study quality varied, often lacking information on sample size calculations. CONCLUSIONS: This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors' medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors' medication adherence.Peer reviewedFinal Published versio

Psychological Determinants of Medication Adherence in Stroke Survivors: : A Systematic Review of Observational Studies

© 2017 The Author (s). This is an Open Access article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.BACKGROUND: Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence. PURPOSE: The aim of this study was to identify psychological determinants that most influence stroke survivors' medication adherence. METHODS: In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953-2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF. RESULTS: Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions ('Emotions' domain) such as anxiety and concerns about medications ('Beliefs about Consequences' domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications ('Knowledge' domain) and stronger beliefs about medication necessity ('Beliefs about Consequences' domain). Study quality varied, often lacking information on sample size calculations. CONCLUSIONS: This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors' medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors' medication adherence.Peer reviewedFinal Published versio

The most luminous, merger-free AGN show only marginal correlation with bar presence

The role of large-scale bars in the fuelling of active galactic nuclei (AGN) is still debated, even as evidence mounts that black hole growth in the absence of galaxy mergers cumulatively dominated and may substantially influence disc (i.e., merger-free) galaxy evolution. We investigate whether large-scale galactic bars are a good candidate for merger-free AGN fuelling. Specifically, we combine slit spectroscopy and Hubble Space Telescope imagery to characterise star formation rates (SFRs) and stellar masses of the unambiguously disc-dominated host galaxies of a sample of luminous, Type-1 AGN with 0.02 < z 0.024. After carefully correcting for AGN signal, we find no clear difference in SFR between AGN hosts and a stellar mass-matched sample of galaxies lacking an AGN (0.013 < z < 0.19), although this could be due to a small sample size (n_AGN = 34). We correct for SFR and stellar mass to minimise selection biases, and compare the bar fraction in the two samples. We find that AGN are marginally (1.7$\sigma$) more likely to host a bar than inactive galaxies, with AGN hosts having a bar fraction, fbar = 0.59^{+0.08}_{-0.09} and inactive galaxies having a bar fraction fbar = 0.44^{+0.08}_{-0.09}. However, we find no further differences between SFR- and mass-matched AGN and inactive samples. While bars could potentially trigger AGN activity, they appear to have no further, unique effect on a galaxy's stellar mass or SFR.Comment: 15 pages (9 figures). Accepted for publication in MNRA

The most luminous, merger-free AGN show only marginal correlation with bar presence

The role of large-scale bars in the fuelling of active galactic nuclei (AGN) is still debated, even as evidence mounts that black hole growth in the absence of galaxy mergers cumulatively dominates and may substantially influence disc (i.e., merger-free) galaxy evolution. We investigate whether large-scale galactic bars are a good candidate for merger-free AGN fuelling. Specifically, we combine slit spectroscopy and Hubble Space Telescope imagery to characterise star formation rates (SFRs) and stellar masses of the unambiguously disc-dominated host galaxies of a sample of luminous, Type-1 AGN with 0.02 < < 0.24. After carefully correcting for AGN signal, we find no clear difference in SFR between AGN hosts and a stellar mass-matched sample of galaxies lacking an AGN (0.013 < < 0.19), although this could be due to small sample size (AGN = 34). We correct for SFR and stellar mass to minimise selection biases, and compare the bar fraction in the two samples. We find that AGN are marginally (∼ 1.7σ) more likely to host a bar than inactive galaxies, with AGN hosts having a bar fraction, bar = 0.59+0.08 −0.09 and inactive galaxies having a bar fraction, bar = 0.44+0.08 −0.09. However, we find no further differences between SFR- and mass-matched AGN and inactive samples. While bars could potentially trigger AGN activity, they appear to have no further, unique effect on a galaxy’s stellar mass or SF

The role of emotions in the choice to adopt, or resist, innovations by Irish dairy farmers

In this paper we uncover the emotional factors that contribute to the adoption, or rejection, of different categories of innovation by dairy farmers in Munster, Republic of Ireland. Although emotions have been extensively researched in different fields, little research to date has examined the effects of emotions on farmers' decision making. Munster is the most important region for grass-based dairy farming in Ireland and this type of farming still plays an important role in Ireland's economy and sense of self. By using in-depth interview data from 27 dairy farmers and 6 other participants in the local industry we identified three categories of innovation that were influenced by different emotional pathways. We further uncovered the strong value-driven emotions that underpin the Irish dairy farmers' beliefs about what farming is, and means, and the influence that this has on innovation choices

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Compositional Analysis of Whole Grains, Processed Grains, Grain Co-Products, and Other Carbohydrate Sources with Applicability to Pet Animal Nutrition

Our objective was to measure the proximate, starch, amino acid, and mineral compositions of grains, grain co-products, and other carbohydrate sources with potential use in pet foods. Thirty-two samples from barley (barley flake, cut barley, ground pearled barley, malted barley, whole pearled barley, pearled barley flakes, and steamed rolled barley); oats (groats, ground oatmeal, ground steamed groats, instant oats, oat bran, oat fiber, oat flour, quick oats, regular rolled oats, steamed rolled oat groats, and steel cut groats); rice (brown rice, polished rice, defatted rice bran, and rice flour); and miscellaneous carbohydrate sources (canary grass seed, hulled millet, whole millet, quinoa, organic spelt hull pellets, potato flake, sorghum, whole wheat, and whole yellow corn) were analyzed. Crude protein, amino acid, fat, dietary fiber, resistant starch, and mineral concentrations were highly variable among the respective fractions (i.e., barley flake vs. malted barley vs. steamed rolled barley) as well as among the various grains (i.e., barley flake vs. brown rice vs. canary grass seed). These ingredients not only provide a readily available energy source, but also a source of dietary fiber, resistant starch, essential amino acids, and macrominerals for pet diets

Biocultural Diversity and Food Sovereignty: A Case Study of Human-Plant Relations in Northwestern Ethiopia

Based on a case study in the Debark District of northwestern Ethiopia, this article investigates how biocultural diversity provides options for food sovereignty. Following a series of semi-structured interviews with 30 farming families in 28 villages, we describe farmers’ relations with plants, including 1) consumption, 2) exchange, 3) use within food system activities, 4) other benefits, and 5) negative impacts to the food system. Farmers identified 123 plants that play a role within their food system. Although the total number of useful plants is highest for non-domesticated and woody species, the average family named more domesticated and herbaceous species. Non-domesticated plants are rarely consumed as food or sold at the local market; however, they play important roles in other food system activities. We introduce a new Substitutability Index to estimate the number of plants available for specific purposes within categories of use and identify strengths and potential vulnerabilities of the Debark food system. We conclude that programs and policies to expand farmers’ relations with plant diversity, by promoting useful semi- and non-domesticated species and facilitating knowledge exchange among communities, could expand options for food sovereignty as a path toward long-term food security