To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission.
We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured.
More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up.
Legal admission status per se did not seem to influence treatment adherence and outcome.
OBJECTIVE: Many patients with chronic heart failure (CHF) are thought to be non-adherent to their prescribed medications. The objective was to describe perceptions about and adherence to regular medicines and study medication at baseline and study end in CHF patients participating in a clinical trial. METHODS: In the carvedilol or metoprolol European trial (COMET), patients (N = 3029) with CHF were randomised and followed during a 58-month period. Patients at some Swedish centres answered a questionnaire at baseline and study end concerning their perception of their regular heart medication and study medication. Adherence was established through estimation of drug usage. RESULTS: In the Swedish sub-study, 302 patients responded once to the questionnaire while 107 patients responded both at baseline and at follow-up. At baseline, 94% of the patients stated that they believed that the study medication would make them feel better and 82% believed that their regular heart medication would do so. During the study, patients' belief in their regular cardiac medication significantly increased. Lack of belief in medication at the start of the study was a strong predictor of withdrawal from the trial (64% versus 6.8%; p
A substantial percentage of North American women are nonadherent to cervical cancer screening guidelines despite the effectiveness of the Papinicolaou (pap) test for papillomavirus. Our objective was to determine factors associated with changes in adherence for cervical cancer screening guidelines over a 14-year period.
Using data from cycles 1 (1994-1995) through 7 (2006-2007) of the Canadian National Population Health Survey, we used logistic regression to compare the regularity of pap testing (at least once every 36 months) among women. We compared women with increasing adherence to pap testing guidelines to those who were never adherent, and women with decreasing adherence to those who were always adherent. The sample included women aged 20-70 years who responded in at least three of seven waves of data collection and had not undergone a hysterectomy (n=4949). Independent variables were based on Andersen's Behavioral Model of predisposing, enabling, and need variables.
The majority of our sample were either always adherent (61.4%) or had increasing adherence (9.9%) over the course of the study. Another 4.8% were never adherent, and 6.6% had decreasing adherence over their involvement in the study. Predominantly, both enabling (e.g., presence of regular doctor) and need (e.g., birth control pill use, obesity) factors were associated with changing patterns of adherence.
Physicians have a crucial role to play in the trajectories of adherence to cervical cancer screening guidelines over time. In addition, women with obesity need to be particularly targeted for services because they are vulnerable to negative trajectories in adherence over time.
There is limited knowledge regarding to what extent the older population meet the recommendations of physical exercise, especially fitness-enhancing exercise. This study assessed participation in health- and fitness-enhancing exercises in people aged >65, and explored to what extent the possible differences in meeting current recommendations differs by age, gender and education.
The study population was derived from the Swedish National study on Aging and Care, and consisted of a random sample of 2593 subjects, aged 65+ years. Participation in health- and fitness-enhancing exercise according to the WHO and the American College of Sports Medicine's recommendations in relation to age, gender and education was evaluated using multinomial logistic regression adjusted for health indicators and physical performance.
According to the recommendations, 46% of the participants fulfilled the criteria for health-enhancing and 16% for fitness-enhancing exercises. Independent of health indicators and physical performance, women
The purpose of the study reported in this paper was to describe adherence to self-care, perceived difficulties and social support in a group of adult patients (n = 213) with insulin-treated diabetes from two outpatient clinics in Northern Finland. Data were collected by questionnaire. The instruments were developed to measure adherence to self-care, difficulties in self-care and social support. The response rate was 76%. One-way ANOVA, logistic regression analysis, contingency and Pearson's correlation coefficients were used in the statistical analysis. A fifth of the respondents were neglecting their self-care. The others undertook flexible, regimen-adherent or self-planned self-care. The subjects had no difficulties with insulin treatment, but had more problems with other aspects of self-care. Poor metabolic control, smoking and living alone predicted neglect of self-care, but if patients had support from family and friends, living alone was not a predictor of neglect of self-care. Those with poor metabolic control perceived themselves as getting peer support from other persons with diabetes.
To determine the efficacy of a pediatric autologous blood donation program.
A retrospective study of patient charts and blood-bank records.
The Children's Hospital of Eastern Ontario, Ottawa, a tertiary care, pediatric centre.
One hundred and seventy-three children who received blood transfusions for a total of 182 procedures between June 1987 and June 1997.
Autologous and homologous blood transfusion required for major surgical intervention, primarily spinal fusion.
Surgeons' accuracy in predicting the number of autologous blood units required for a given procedure, compliance rate (children's ability to donate the requested volume of blood), utilization rate of autologous units and rate of allogeneic transfusion.
The surgeons' accuracy in predicting the number of autologous units required for a given procedure was 53.8%. The compliance rate of children to donate the requested amount of blood was 80.3%. In children below the standard age and weight criteria for blood donation the compliance rate was 75.5%. The utilization rate of autologous units obtained was 84.4% and the incidence of allogeneic transfusion was 26.6%.
There was a high rate of compliance and utilization of predonated autologous blood in the children in the study. Preoperative blood donation programs are safe and effective in children, even in those below the standard age and weight criteria of 10 years and 40 kg.
Discharges against medical advice (DAMA) have been considered predictors of adverse outcomes for patients in acute care and psychiatric hospitals. However, little is known about the profile of patients who discharge AMA admitted to rehabilitation hospitals. The aims of this study were to provide a profile of patients who received inpatient rehabilitation services following a traumatic brain injury (TBI) who discharged AMA and to compare this group with the regular discharge group.
Retrospective cohort study.
Hospital discharge data from two national administrative databases were reviewed for the years 2001-2006.
The databases yielded 1559 cases of TBI (average length of stay?=?51 days). Of these, 31 (2.0%) had recorded DAMA events: one in 50 patients left rehabilitation against medical advice. Compared to regular discharge (n?=?1247), DAMA was significantly associated with unemployment, intentional injury, higher motor functions at admission and shorter length of stay. Known factors for DAMA in acute hospitals, such as male sex, young age and substance abuse history, were not significant.
Careful screening and assessment of patients who discharge AMA could enable better prevention and management strategies, thus improving health outcomes and enhancing healthcare delivery.
OBJECTIVE: To identify important factors that can influence patient compliance with prescribed medication and to elucidate aspects of asthma care from the patient's point of view. DESIGN: Field investigation; the interviewer used a semi-structured questionnaire. SETTING: Patients with asthma in primary health care settings in Sweden. STUDY PARTICIPANTS: A sample of 77 patients was randomly selected from 11 primary health care centres in southern Sweden; 63 of these patients participated in the study. CONCLUSION: The factors of importance for self-reported compliance with prescribed medication were age, gender, duration of the disease, the attitude of the staff and information/education about asthma. The patients expressed important aspects of care, and these are in accordance with how an asthma nurse practice functions in Sweden.
This qualitative research aims to understand, from the standpoint of the family physician, the barriers to treating depression in the office setting. Three primary barriers to treating depression in the family physician's office were identified: systemic, physician-related, and patient-related. The systemic barriers involved the shortage of qualified, publicly-funded counsellors, lack of locally available counselling, and the cost of medication. Physician-related barriers included lack of time and expertise, and inadequacies of the reimbursement system. Patient-related barriers were rooted in the stigma attached to depression and failure to comply with treatment.
Psychological determinants of brace-wear compliance were analyzed among 113 patients who used a brace because of an adolescent idiopathic scoliosis (92%), kyphosis (5%), or both (3%). The results showed that noncompliant girls did not expect to succeed in dealing with scoliosis and that they were anxious about the possibility of failure. They also had low self-esteem and did not seek social support from other people. Noncompliant boys, in contrast, had high self-esteem and high achievement success expectation. Among patients with a short time of brace use, low compliance was best predicted by low amount of reflective thinking and a good body-image. In turn, among patients who had used the brace for >6 months, low compliance was best predicted by high amount of reflective thinking, poor body-image, low social success expectation, and low master orientation in social behavior. Only sleeping problems predicted compliance across gender and the time of brace use: the more the patients experienced sleeping problems, the less they used the brace.