Cognitive and behavioral predictors of light therapy use

Objective: Although light therapy is effective in the treatment of seasonal affective disorder (SAD) and other mood disorders, only 53-79% of individuals with SAD meet remission criteria after light therapy. Perhaps more importantly, only 12-41% of individuals with SAD continue to use the treatment even after a previous winter of successful treatment. Method: Participants completed surveys regarding (1) social, cognitive, and behavioral variables used to evaluate treatment adherence for other health-related issues, expectations and credibility of light therapy, (2) a depression symptoms scale, and (3) self-reported light therapy use. Results: Individuals age 18 or older responded (n = 40), all reporting having been diagnosed with a mood disorder for which light therapy is indicated. Social support and self-efficacy scores were predictive of light therapy use (p's<.05). Conclusion: The findings suggest that testing social support and self-efficacy in a diagnosed patient population may identify factors related to the decision to use light therapy. Treatments that impact social support and self-efficacy may improve treatment response to light therapy in SAD. © 2012 Roecklein et al

Potassium acetate solution as a promising option to osmotic distillation for sour cherry (Prunus cerasus L.) juice concentration

Different osmotic agents (OA), such as potassium acetate (CH3COOK), potassium carbonate (K2CO3) and ammonium nitrate (NH4NO3), have been examined as alternatives to the traditionally used calcium chloride (CaCl2) for osmotic distillation concentrating of clarified and pre-concentrated sour cherry (Prunus cerasus L.) juice. Comparison of the process performances based on the permeate fluxes has been carried out. Regarding the permeate flux results, simplified estimation of the overall mass transfer coefficient of the most effective osmotic agent and the reference (CaCl2) solution has been also performed. Furthermore, analytical methods such as total antioxidant activity (TAA) and total polyphenolic content (TPC) using spectrophotometric assays have been also carried out to evaluate the effect of the osmotic distillation on the valuable compounds content of concentrated sour cherry juice. CH3COOK was found to be the most effective, resulted more than 25% higher permeate flux during the sour cherry juice concentration. K2CO3 and NH4NO3 were less effective. The simplified mass transfer estimation showed that the CH3COOK is more effective only at near saturated concentrations compared to the CaCl2. Regarding the TAA and TPC contents, a significant loss was found in case of all OAs during the concentration procedures

Sociocultural considerations in aging men's health: implications and recommendations for the clinician

http://dx.doi.org/10.1016/j.jomh.2009.07.00

Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns

Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

We examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year adverse clinical events. The incidence of 3-year death/non-fatal myocardial infarction was 3.5% in patients with no risk factors (neither hopelessness nor diabetes), 8.2% in patients with diabetes, 11.2% in patients with high hopelessness, and 15.9% in patients with both factors (p = 0.001). Patients with hopelessness (HR: 3.28; 95% CI: 1.49-7.23) and co-occurring diabetes and hopelessness (HR: 4.89; 95% CI: 1.86-12.85) were at increased risk of 3-year adverse clinical events compared to patients with no risk factors, whereas patients with diabetes were at a clinically relevant but not statistically significant risk (HR: 2.40; 95% CI: 0.82-7.01). These results remained, adjusting for baseline characteristics an

Neutrino transport in accretion disks

We test approximate approaches to solving a neutrino transport problem that presents itself in the analysis of some accretion-disk models. Approximation #1 consists of replacing the full, angular- dependent, distribution function by a two-stream simulation, where the streams are respectively outwardly and inwardly directed, with angles $\cos \theta=\pm 1/\sqrt{3}$ to the vertical. In this approximation the full energy dependence of the distribution function is retained, as are the energy and temperature dependences of the scattering rates. Approximation #2, used in recent works on the subject, replaces the distribution function by an intensity function and the scattering rates by temperature-energy-averaged quantities. We compare the approximations to the results of solving the full Boltzmann equation. Under some interesting conditions, approximation #1 passes the test; approximation #2 does not. We utilize the results of our analysis to construct a toy model of a disc at a temperature and density such that relativistic particles are more abundant than nucleons, and dominate both the opacity and pressure. The nucleons will still provide most of the energy density. In the toy model we take the rate of heat generation (which drives the radiative transfer problem) to be proportional to the nucleon density. The model allows the simultaneous solution of the neutrino transport and hydrostatic equilibrium problems in a disk in which the nucleon density decreases approximately linearly as one moves from the median plane of the disk upwards, reaching zero on the upper boundary.Comment: 8 pages, 5 figures Parentheses added in eqs. 10-1

Associations of specific phobia and its subtypes with physical diseases: an adult community study.

Specific phobia is the most prevalent anxiety disorder in the community and is associated with substantial impairment. Comorbidity with physical diseases is assumed and has important implications for etiology, treatment, or prevention of the comorbid conditions. However, due to methodological issues data are limited and subtypes of specific phobia have not been investigated yet. We examined the association of specific phobia and its subtypes with physical diseases in a representative community sample with physician-diagnosed physical diseases and diagnostic criteria of specific phobia. Data of the German Mental Health Survey from 4181 subjects aged 18-65 years were used. Specific phobia was diagnosed using M-CIDI/DIA-X interview; physical diseases were assessed through a self-report questionnaire and a medical interview. Logistic regression analyses adjusted for sex were calculated. Specific phobia was associated with cardiac diseases, gastrointestinal diseases, respiratory diseases, arthritic conditions, migraine, and thyroid diseases (odds ratios between 1.49 and 2.53). Among the subtypes, different patterns of associations with physical diseases were established. The findings were partially replicated in the Swiss PsyCoLaus Study. Our analyses show that subjects with specific phobia have an increased probability for specific physical diseases. From these analyses etiological mechanisms of specific phobia and physical disease can be deduced. As subtypes differed in their patterns of associations with physical diseases, different etiological mechanisms may play a role. The findings are highly relevant for public health in terms of prevention and therapy of the comorbid conditions

Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event

addresses: Peninsula College of Medicine and Dentistry, St Luke's Campus, University of Exeter, Exeter, UK. [email protected]: PMCID: PMC3528446types: Journal Article; Research Support, Non-U.S. Gov't© 2012 Warren et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention

Medication adherence among diabetic and hypertensive patients in Al-Qassim region of Saudi Arabia

Non-adherence to medication is often an unrecognized risk factor that contributes to failure of the therapeutic plan. The purpose of the study was to identify factors related to high, medium and low medication adherence among adult Saudi patients with hypertension and diabetes mellitus. This study is designed as a descriptive cross sectional survey and was conducted in three tertiary care hospitals of Al-Qassim province of Saudi Arabia. The data was collected using the 8-item Morisky Medication Adherence Scale (MMAS-8) and analyzed by SPSS. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); 8 (high). Of the 396 patients interviewed, 52% reported low adherence to prescribed medication. Multinomial logistic regression analysis was conducted. Gender, age, literacy level, duration of illness and type of chronic disease were negatively associated with medication adherence. The study shows very high proportion of low and medium adherence on long term medication, which may be responsible for the failure of achieving therapeutic outcome. Further investigation is required to evaluate the applicability of MMAS-8 as a tool of measuring medication adherence among Saudi patients with chronic diseases. Adherence enhancing strategies should also be evaluated in separate patients group