Relations between cognitive status and medication adherence in patients treated for memory disorders.

Medication adherence has been increasingly recognized as an important factor in elderly persons\u27 health. Various studies have shown that medication non-adherence is associated with poor health status in this population. As part of a study of the effects of two interventions to promote medication adherence in patients treated for memory problems, information on medication adherence and cognitive status was collected at 3-month intervals. Twenty-seven participants (16 men, 11 women, age 71-92 years) were assigned to control or treatment conditions and adherence was evaluated with an electronic monitoring device. Cognitive status was evaluated at 3-month intervals beginning in April of 2003 and continuing through September of 2006. We have previously reported on the effectiveness of these interventions to promote adherence. In this paper, we examine the relations of cognitive status and adherence over time using a partial least squares path model in order to evaluate the extent to which adherence to cholinesterase medications was related to cognitive status. Adherence predicted cognitive status at later time points while cognition did not, in general, predict adherence. Results thus suggest that interventions to ensure high levels of medication adherence may be important for maintaining cognitive function in affected elderly people

Tailored Information and Automated Reminding to Improve Medication Adherence in Spanish- and English-Speaking Elders Treated for Memory Impairment.

Medication adherence is recognized as an issue of critical importance within health care, as many patients do not take their medications as prescribed. This study evaluated two interventions targeted at improving adherence in elderly patients being treated for memory impairments. Twenty-seven participants were randomly assigned to control (n = 11), automated reminding (n = 8), or tailored information conditions (n = 8). Medication adherence was evaluated with an electronic pill bottle. Generalized estimating equation (GEE) models assessed the effects of the interventions on electronically monitored medication adherence after controlling for covariates. Results showed that individuals in both intervention groups had higher levels of medication adherence than those in the control group. The presence of a caregiver was associated with substantially higher levels of adherence. Verbal memory, but not general cognitive status, predicted better adherence. Mood, health literacy, and executive functions were not associated with adherence. Results thus suggest that both automated reminding and tailored information interventions may improve medication adherence in elders, even among those with memory impairments

Factors related to medication adherence in memory disorder clinic patients.

Medication adherence is a substantial problem in the elderly. It may be even more important among elderly persons with memory problems, since other factors that lead to non-adherence may be compounded with the memory problems themselves. The objective was to determine whether a model that integrates research on medication adherence from several research domains is useful in understanding adherence in elderly patients. The methodology involved a cross-sectional observational study using a convenience sample of 63 patients drawn from a university-affiliated outpatient memory disorders clinic. The primary measure of medication adherence was caregivers\u27 reports of patients\u27 medication adherence. Patients and their caregivers were asked questions assessing their beliefs about the seriousness of each condition for which a medication was prescribed and the likely outcome of that condition without treatment. Additional data collected included presence of side effects, total number of medications taken, and patients\u27 mood and cognitive status. Multilevel path analysis confirmed several model-based predictions. Caregivers\u27 reports of adherence were predicted by estimates of disease outcome, the presence of side effects, and patients\u27 relying on themselves to remember to take medications. Results partially confirm the integrative model in understanding medication adherence in these patients. Patients\u27 beliefs about the likely effect of medication treatment for their condition and the presence of side effects influence reported medication adherence. Results thus suggest that efforts to educate patients about the likely response of their medical condition to treatment and to assess and deal with medication side effects might improve patient adherence

The Effects of News Commentary on the Image of Political Debaters: An Experimental Study

The purpose of this study was to examine the effects of news commentary on the image of political candidates. Subjects were exposed to a political debate, which was followed by three experimental manipulations of a news commentary. One group saw a commentary biased toward one candidate and against the other. In a second group the bias was reversed. A third experimental group saw a neutral commentary and the control group viewed the debate but no commentary. The primary statistical analyses used were a multivariate analysis of variance, a multiple discriminant analysis and a factor analysis. The results indicated that the commentary did have some effects on the perception of the candidates' images. Furthermore, the commentaries affected the amount of the candidates' message which was recalled by the subjects, and cued the subjects to recall specific issues which were mentioned in the commentaries. Finally, the factor analysis indicated certain characteristics of the images of political candidates

Patient Activation with Knowledge, Self-Management, and Confidence in Chronic Kidney Disease

Background Chronic kidney disease is a growing health problem on a global scale. The increasing prevalence of chronic kidney disease presents an urgent need to better understand the knowledge, confidence and engagement in self-managing the disease. Objectives This study examined group differences in patient activation and health-related quality of life, knowledge, self-management and confidence with managing chronic disease across all five stages of chronic kidney disease. Design The study employed a descriptive correlational design. Settings Participants were recruited from five primary care, three nephrology clinics and one dialysis centre in two Midwestern cities in the United States. Participants The convenience sample included 85 adults with hypertension, diabetes mellitus and chronic kidney disease, including kidney failure, who spoke English. Measurements Seven measurements were used to collect data via telephone interviews with participants not receiving haemodialysis, and face-to-face interviews with those receiving haemodialysis at the beginning of their treatment session. Results Analyses indicated that half the participants were female (50.58%), the mean age was 63.21 years (SD = 13.11), and participants with chronic kidney disease stage 3 were the most activated. Post hoc differences were significant in patient activation and blood pressure self-management and anxiety across chronic kidney disease stages, excluding stage 5. Conclusion Engaging patients in the self-management of their health care and enhancing patients’ ability to self-manage their blood pressure may work to preserve kidney health. Healthcare providers should collaborate with patients to develop strategies that will maintain patients’ health-related quality of life, like reducing anxiety as kidney disease progress

Infection with a Brazilian isolate of Zika virus generates RIG‐I stimulatory RNA and the viral NS5 protein blocks type I IFN induction and signalling

Zika virus (ZIKV) is a major public health concern in the Americas. We report that ZIKV infection and RNA extracted from ZIKV infected cells potently activated the induction of type I interferons (IFNs). This effect was fully dependent on the mitochondrial antiviral signalling protein (MAVS), implicating RIG‐I‐like receptors (RLRs) as upstream sensors of viral RNA. Indeed, RIG‐I and the related RNA sensor MDA5 contributed to type I IFN induction in response to RNA from infected cells. We found that ZIKV NS5 from a recent Brazilian isolate blocked type I IFN induction downstream of RLRs and also inhibited type I IFN receptor (IFNAR) signalling. We defined the ZIKV NS5 nuclear localization signal and report that NS5 nuclear localization was not required for inhibition of signalling downstream of IFNAR. Mechanistically, NS5 blocked IFNAR signalling by both leading to reduced levels of STAT2 and by blocking phosphorylation of STAT1, two transcription factors activated by type I IFNs. Taken together, our observations suggest that ZIKV infection induces a type I IFN response via RLRs and that ZIKV interferes with this response by blocking signalling downstream of RLRs and IFNAR