Medication adherence perspectives in haemodialysis patients: a qualitative study

Background: End-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence. The aims of this study were to explore factors associated with medication adherence, and, to examine the differential perspectives on medication-taking behaviour shown by adherent and nonadherent haemodialysis patients. Methods: A qualitative exploratory design was used. One-on-one semi-structured interviews were conducted with 30 haemodialysis patients at the outpatient dialysis facility in Hobart, Australia. Patient self-reported adherence was measured using 4-item Morisky Green Levine scale. Interview transcripts were thematically analysed and mapped against the World Health Organization (WHO) determinants of medication adherence. Results: Participants were 44–84 years old, and were prescribed with 4–19 medications daily. More than half of the participants were nonadherent to their medications based on self-reported measure (56.7%, n = 17). Themes mapped against WHO adherence model comprised of patient-related (knowledge, awareness, attitude, self-efficacy, action control, and facilitation); health system/ healthcare team related (quality of interaction, and mistrust and collateral arrangements); therapy-related (physical characteristics of medicines, packaging, and side effects); condition-related (symptom severity); and social/ economic factors (access to medicines, and relative affordability). Conclusions: Patients expressed a number of concerns that led to nonadherence behaviour. Many of the issues identified were patient-related and potentially modifiable by using psycho-educational or cognitive-behavioural interventions. Healthcare professionals should be more vigilant towards identifying these concerns to address adherence issues. Future research should be aimed at understanding healthcare professionals’ perceptions and practices of assessing medication adherence in dialysis patients that may guide intervention to resolve this significant issue of medication non-adherence

Integrated use of fertilizer micro-dosing and Acacia tumida mulching increases millet yield and water use efficiency in Sahelian semi-arid environment

Limited availability of soil organic amendments and unpredictable rainfall, decrease crop yields drastically in the Sahel. There is, therefore, a need to develop an improved technology for conserving soil moisture and enhancing crop yields in the Sahelian semi-arid environment. A 2-year field experiment was conducted to investigate the mulching effects of Acacia tumida pruning relative to commonly applied organic materials in Niger on millet growth, yields and water use efficiency (WUE) under fertilizer micro-dosing technology. We hypothesized that (1) A. tumida pruning is a suitable mulching alternative for crop residues in the biomass-scarce areas of Niger and (2) combined application of A. tumida mulch and fertilizer micro-dosing increases millet yield and water use efficiency. Two fertilizer micro-dosing options (20 kg DAP ha−1, 60 kg NPK ha−1) and three types of organic mulches (millet straw, A. tumida mulch, and manure) and the relevant control treatments were arranged in factorial experiment organized in a randomized complete block design with four replications. Fertilizer micro-dosing increased millet grain yield on average by 28 %. This millet grain yield increased further by 37 % with combined application of fertilizer micro-dosing and organic mulch. Grain yield increases relative to the un-mulched control were 51 % for manure, 46 % for A. tumida mulch and 36 % for millet mulch. Leaf area index and root length density were also greater under mulched plots. Fertilizer micro-dosing increased WUE of millet on average by 24 %, while the addition of A. tumida pruning, manure and millet increased WUE on average 55, 49 and 25 %, respectively. We conclude that combined application of micro-dosing and organic mulch is an effective fertilization strategy to enhance millet yield and water use efficiency in low-input cropping systems and that A. tumida pruning could serve as an appropriate mulching alternative for further increasing crop yields and water use efficiency in the biomass-scarce and drought prone environment such as the Sahel. However, the economic and social implications and the long-term agronomic effects of this agroforestry tree in Sahelian millet based system have to be explored further

Association analysis of low-phosphorus tolerance in West African pearl millet using DArT markers

Pearl millet [Pennisetum glaucum (L.) R. Br.] is a food security crop in the harshest agricultural regions of the world. While low soil phosphorus (P) availability is a big constraint on its production, especially in West Africa (WA), information on genomic regions responsible for low-P tolerance in pearl millet is generally lacking. We present the first report on genetic polymorphisms underlying several plant P-related parameters, flowering time (FLO) and grain yield (GY) under P-limiting conditions based on 285 diversity array technology markers and 151 West African pearl millet inbred lines phenotyped in six environments in WA under both high-P and low-P conditions. Nine markers were significantly associated with P-related traits, nine markers were associated with FLO, whereas 13 markers were associated with GY each explaining between 5.5 and 15.9 % of the observed variation. Both constitutive and adaptive associations were observed for FLO and GY, with markers PgPb11603 and PgPb12954 being associated with the most stable effects on FLO and GY, respectively, across locations. There were a few shared polymorphisms between traits, especially P-efficiency-related traits and GY, implying possible colocation of genomic regions responsible for these traits. Our findings help bridge the gap between quantitative and molecular methods of studying complex traits like low-P tolerance in WA. However, validation of these markers is necessary to determine their potential applicability in marker-assisted selection programs targeting low-P environments, which are especially important in WA where resource-poor farmers are expected to be the hardest hit by the approaching global P crisis

Adaptive density estimation in the pile-up model involving measurement errors

http://imstat.org/ejs/International audienc