The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients

Purpose: The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. Method: In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. Results: At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p < 0.05). In demographic characteristic, only age indicated a positive correlation with adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p < 0.05). Conclusions: Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. ▸ Implications for Rehabilitation • Adherence to treatment means that all patients behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. • There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. • Individual structured programs are most likely to be successful in encouraging adherence to treatment. © 2015 Informa UK Ltd. All rights reserved

Acceleration and Substructure Constraints in a Quasar Outflow

We present observations of probable line-of-sight acceleration of a broad absorption trough of C IV in the quasar SDSS J024221.87+004912.6. We also discuss how the velocity overlap of two other outflowing systems in the same object constrains the properties of the outflows. The Si IV doublet in each system has one unblended transition and one transition which overlaps with absorption from the other system. The residual flux in the overlapping trough is well fit by the product of the residual fluxes in the unblended troughs. For these optically thick systems to yield such a result, at least one of them must consist of individual subunits rather than being a single structure with velocity-dependent coverage of the source. If these subunits are identical, opaque, spherical clouds, we estimate the cloud radius to be r = 3.9 10^15 cm. If they are identical, opaque, linear filaments, we estimate their width to be w = 6.5 10^14 cm. These subunits are observed to cover the Mg II broad emission line region of the quasar, at which distance from the black hole the above filament width is equal to the predicted scale height of the outer atmosphere of a thin accretion disk. Insofar as that scale height is a natural size scale for structures originating in an accretion disk, these observations are evidence that the accretion disk can be a source of quasar absorption systems. Based on data from ESO program 075.B-0190(A).Comment: 14 emulateapj pages, 7 figures, ApJ in pres

Basic Criteria, Models, and Indicators of Intersectoral Collaboration in Health Promotion: A Scoping Review

Background: In this study, the basic criteria, models, and indicators of intersectoral collaboration in health promotion were investigated to facilitate the implementation of collaboration.&#x0D; Methods: This scoping review was conducted using datasets of Embase, Web of Science, Scopus, and PubMed, and search engines of Google, Google Scholar, and ProQuest.&#x0D; Results: 52 studies were included, and 32 codes in Micro, Meso, and Macro level, were obtained. Micro-level criteria had the highest frequency. Among the models used in the reviewed studies, social network analysis, Diagnosis of Sustainable Collaboration, Bergen, and logic models had the highest frequency. Among the indicators studied, the number of participants and the level of collaboration as well as its sustainability were the most frequent indicators.&#x0D; Conclusion: The findings identified the most important and widely used criteria, models, and indicators of intersectoral collaboration in health promotion which can be useful for decision-makers and planners in the domain of health promotion, in designing, implementing, and evaluating collaborative programs.</jats:p

Alterations to cerebral perfusion, metabolite profiles, and neuronal morphology in the hippocampus and cortex of male and female mice during chronic exposure to a high-salt diet

Excess dietary salt reduces resting cerebral blood flow (CBF) and vascular reactivity, which can limit the fueling of neuronal metabolism. It is hitherto unknown whether metabolic derangements induced by high-salt-diet (HSD) exposure during adulthood are reversed by reducing salt intake. In this study, male and female mice were fed an HSD from 9 to 16 months of age, followed by a normal-salt diet (ND) thereafter until 23 months of age. Controls were continuously fed either ND or HSD. CBF and metabolite profiles were determined longitudinally by arterial spin labeling magnetic resonance imaging and magnetic resonance spectroscopy, respectively. HSD reduced cortical and hippocampal CBF, which recovered after dietary salt normalization, and affected hippocampal but not cortical metabolite profiles. Compared to ND, HSD increased hippocampal glutamine and phosphocreatine levels and decreased creatine and choline levels. Dietary reversal only allowed recovery of glutamine levels. Histology analyses revealed that HSD reduced the dendritic arborization and spine density of cortical and hippocampal neurons, which were not recovered after dietary salt normalization. We conclude that sustained HSD exposure throughout adulthood causes permanent structural and metabolic alterations to the mouse brain that are not fully normalized by lowering dietary salt during aging