The AdHOC study of older adults’ adherence to medication in 11 countries

BACKGROUND: Compared with the resources expended developing, evaluating and making clinical decisions about prescribing medication, we know little about what determines whether people take it. Older adults are prescribed more medication than any other group. Poor adherence is a common reason for nonresponse to medication. OBJECTIVES: To investigate cross-nationally the impact of demographic, psychiatric (including cognitive), physical health, behavioural and medication factors on adherence to medication in older adults. METHODS: Researchers interviewed 3881 people over 65 who receive home care services using a structured interview at participants’ places of residence in eleven countries. The main outcome measure was the percentage participants not adherent to medication. RESULTS: 12.5% (n= 456) of people reported they were not fully adherent to medication. Non-adherence was predicted by problem drinking (OR=3.6), not having a doctor review medication (OR=3.3), dementia (OR=1.4 for every one point increase in impairment), good physical health (OR=1.2), resisting care (OR=2.1) being married (OR=2.3) and living in the Czech Republic (OR=4.7) or Germany (OR=1.4). CONCLUSION: People, who screen positive for problem drinking and with dementia, often undiagnosed are less likely to adhere to medication. Therefore doctors should consider dementia and problem drinking when prescribing for older adults. Interventions to improve adherence in older adults might be more effective if 4 targeted at these groups. It is possible that medication review enhances adherence, by improving the patient-doctor relationship, or by emphasising the relevance of medications

Inefficiencies in Digital Advertising Markets

Digital advertising markets are growing and attracting increased scrutiny. This article explores four market inefficiencies that remain poorly understood: ad effect measurement, frictions between and within advertising channel members, ad blocking, and ad fraud. Although these topics are not unique to digital advertising, each manifests in unique ways in markets for digital ads. The authors identify relevant findings in the academic literature, recent developments in practice, and promising topics for future research

Refugees Who Have Experienced Extreme Cruelty: A Qualitative Study of Mental Health and Wellbeing after Being Granted Leave to Remain in the UK

This study explores how vulnerable refugees’ experiences in the first year after being granted leave to remain in the UK impact on mental health and wellbeing. Nine semi-structured interviews were conducted with refugee survivors of extreme cruelty. Data were analyzed using thematic analysis with a narrative influence. Reported challenges included requirements to organize housing, finances and welfare benefits rapidly. Most respondents reported low mood, worry, exacerbated PTSD symptoms, physical ailments and isolation, but valued stable housing, meaningful activities, emotional support and service provider sensitivity in managing this transition. Policy and service recommendations are made, to assist integration and improve wellbeing

Monetary costs of agitation in older adults with Alzheimer's disease in the UK: prospective cohort study

While nearly half of all people with Alzheimer's disease (AD) have agitation symptoms every month, little is known about the costs of agitation in AD. We calculated the monetary costs associated with agitation in older adults with AD in the UK from a National Health Service and personal social services perspective

Finding agency in limbo: a qualitative investigation into the impact of occupational engagement on mental health and wellbeing of asylum seekers in the U.K.

The process of seeking asylum is complex, and often leads to extended periods of limbo for millions of people awaiting decisions on their status. Engagement in occupation – defined as meaningful activities and roles that bring purpose and agency to one’s life- is suggested as a key driver for mental health recovery for marginalised populations, including asylum seekers with traumatic experiences pre- and post-migration. How does occupational engagement impact one’s mental health and wellbeing while existing in the asylum system? How do asylum seekers maintain engagement in occupation in the context of socio-political constraints of the asylum process? We explored the occupational experiences of 12 clients of one human-rights charity, utilising community-based participatory research methods. Participants completed group mapping sessions (n =4 sessions with 11 total participants) where participants depicted routine journeys taken to perform occupations in London, which included discussion around the significance of their journeys. Four participants also completed additional “walking maps” - semi-structured interviews which occurred along a selected “occupational journey” self-identified as meaningful to their wellbeing. All Data were analysed using thematic network analysis. Findings revealed that engagement in routine occupations within safe, social spaces positively affects the mental wellbeing of asylum seekers by promoting competence, agency and feelings of belonging. The liminal space of the asylum process meant that participants’ occupational engagement was limited to ‘leisure’ activities but were still critical to establishing forms of agency associated with their wellbeing. Implications for programmes and interventions responding to the needs of asylum seekers are discusse

Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia

Objective: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia.Method: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria.Results: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed.Conclusions: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research ( only nine level-1 studies were identified). More high-quality investigation is needed

An analytical approach to 3D orthodontic load systems

OBJECTIVE: To present and demonstrate a pseudo three-dimensional (3D) analytical approach for the characterization of orthodontic load (force and moment) systems. MATERIALS AND METHODS: Previously measured 3D load systems were evaluated and compared using the traditional two-dimensional (2D) plane approach and the newly proposed vector method. RESULTS: Although both methods demonstrated that the loop designs were not ideal for translatory space closure, they did so for entirely different and conflicting reasons. CONCLUSIONS: The traditional 2D approach to the analysis of 3D load systems is flawed, but the established 2D orthodontic concepts can be substantially preserved and adapted to 3D with the use of a modified coordinate system that is aligned with the desired tooth translation

Geometric system analysis of ILMD-based LID measurement systems using Monte-Carlo simulation

Imaging Luminance Measuring Device (ILMD) based luminous intensity distribution measurement systems are an established method for measuring the luminous intensity distribution (LID) of light sources in the far field. The advantage of this system is the high-resolution acquisition of a large angular range with one image. For the uncertainty budget, the mathematical description of the system can be divided into photometric and geometric contributions. In the following, we will present a Monte-Carlo approach to analyse the geometric contributions which are the uncertainty of measurement direction and measurement distance. Therefore, we set up a geometric system description based on kinematic transformations that describes the connection between detector and light source position. To consider all relevant input quantities we simulate the adjustment and measurement process. Finally, an analysis of the geometric input parameters is shown