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The purpose of this study was to examine the relationship between Health Action Process Approach (HAPA) postintentional constructs (maintenance self-efficacy, recovery self-efficacy, action planning, coping planning) and medication adherence among phase II cardiac rehabilitation (CR) patients. Purposive sampling was used to recruit 91 phase II CR patients age 50 years and over. All respondents completed paper and pencil questionnaire examining HAPA postintentional constructs (action planning, coping planning, maintenance self-efficacy, recovery self-efficacy), medication adherence, and demographic characteristics. Validity and reliability were confirmed for all scales included in the questionnaire. Descriptive statistics were used to describe respondents’ characteristics. Bivariate statistics (correlation, Mann-Whitney U-test, Kruskal Wallis test) were used to examine associations between medication adherence and each HAPA postintention construct as well as medication adherence and respondent demographic characteristics. Better medication adherence was associated with greater maintenance self-efficacy (r = −.290, p = .006) and better action planning skills (r = −.233,p = .027) and coping planning skills (r = −.277,p = .008) as indicated by higher scores on the maintenance self-efficacy, action planning, and coping planning scales. There was no significant linear relationship between medication adherence and recovery self-efficacy (r = −.103,p = .335) or medication adherence and any of the respondents’ demographic characteristics (p > .05). Only maintenance self-efficacy remained significant in a multivariate model predicting medication adherence. Greater maintenance self-efficacy was associated with increased medication adherence; health professionals working in CR settings might consider opportunities to enhance maintenance self-efficacy for medication adherence. Additional research is needed to identify strategies for promoting maintenance self-efficacy for medication adherence. [ABSTRACT FROM AUTHOR]

This study suggests that use of embalming fluid as a mind-altering drug has been underreported. Based on a social network recruitment strategy, findings from a study in 2000 of 401 outreach worker-recruited polydrug-involved youth (ages 16–24 years) from the inner city of Hartford, CT indicate widespread (over 80% of study participants had used the drug at least once) and regular use of embalming fluid mixed with either marijuana or mint. This paper reports findings on frequency and distribution of use, experience, and consequences of use, access to the drug, and characteristics of embalming fluid users. Given the toxic substances that comprise embalming fluid, and the tendency, affirmed in the present study, of the drug to be associated with violent behavior, there is a need to recognize embalming fluid as a drug of concern among youth. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is an adverse event that carries significant morbidity. Given that interventions after AKI occurrence have poor performance, there is substantial interest in prediction of AKI prior to its diagnosis. However, integration of real-time prognostic modeling into the electronic health record (EHR) has been challenging, as complex models increase the risk of error and complicate deployment. Our goal in this study was to create an implementable predictive model to accurately predict AKI in hospitalized patients and could be easily integrated within an existing EHR system.Methods and Findings: We performed a retrospective analysis looking at data of 169,859 hospitalized adults admitted to one of three study hospitals in the United States (in New Haven and Bridgeport, Connecticut) from December 2012 to February 2016. Demographics, medical comorbidities, hospital procedures, medications, and laboratory data were used to develop a model to predict AKI within 24 hours of a given observation. Outcomes of AKI severity, requirement for renal replacement therapy, and mortality were also measured and predicted. Models were trained using discrete-time logistic regression in a subset of Hospital 1, internally validated in the remainder of Hospital 1, and externally validated in Hospital 2 and Hospital 3. Model performance was assessed via the area under the receiver-operator characteristic (ROC) curve (AUC). The training set cohort contained 60,701 patients, and the internal validation set contained 30,599 patients. External validation data sets contained 43,534 and 35,025 patients. Patients in the overall cohort were generally older (median age ranging from 61 to 68 across hospitals); 44%-49% were male, 16%-20% were black, and 23%-29% were admitted to surgical wards. In the training set and external validation set, 19.1% and 18.9% of patients, respectively, developed AKI. The full model, including all covariates, had good ability to predict imminent AKI for the validation set, sustained AKI, dialysis, and death with AUCs of 0.74 (95% CI 0.73-0.74), 0.77 (95% CI 0.76-0.78), 0.79 (95% CI 0.73-0.85), and 0.69 (95% CI 0.67-0.72), respectively. A simple model using only readily available, time-updated laboratory values had very similar predictive performance to the complete model. The main limitation of this study is that it is observational in nature; thus, we are unable to conclude a causal relationship between covariates and AKI and do not provide an optimal treatment strategy for those predicted to develop AKI.Conclusions: In this study, we observed that a simple model using readily available laboratory data could be developed to predict imminent AKI with good discrimination. This model may lend itself well to integration into the EHR without sacrificing the performance seen in more complex models. [ABSTRACT FROM AUTHOR]

Patient and regimen persistence in HIV-infected drug users are largely unknown. We evaluated patterns of medication non-persistence among HIV-infected drug users enrolled in a prospective, 6-month randomized controlled trial of directly administered antiretroviral therapy (DAART). Medication-taking behavior was assessed via direct observation and MEMS data. Of 74 participants who initiated DAART, 59 (80%) subjects were non-persistent with medication for 3 or more consecutive days. Thirty-one participants (42%) had 2 or more episodes of non-persistence. Higher depressive symptoms were strongly associated with non-persistence episodes of ≥ 3 days (AOR: 17.4, P = 0.02) and ≥ 7 days AOR: 5.4, P = 0.04). High addiction severity (AOR 3.2, P = 0.03) was correlated with non-persistence ≥ 7 days, and injection drug use (AOR: 15.2, P = 0.02) with recurrence of non-persistence ≥ 3 days. Time to regimen change was shorter for NNRTI-based regimens compared to PI-based ones (HR: 3.0, P = 0.03). There was no significant association between patterns of patient non-persistence and virological outcomes. [ABSTRACT FROM AUTHOR]

Ethnic disparities exist when comparing glycemic control: Latino patients have suboptimal glycemic control as compared to non-Latino whites. A key factor to achieving optimal diabetes management and control is medication adherence. We conducted a nested, cross-sectional retrospective study of data ( n = 61) collected from a larger parallel, randomized, longitudinal study conducted at an urban primary care practice examining a culturally tailored community-based peer counselor intervention. Baseline demographic and medication utilization covariates were evaluated for eligibility into the multivariate logistic regression to predict medication adherence. Significant correlates of medication adherence were physician or healthcare team support (OR 12.79, 95% CI 1.04, 157.21), and increasing numbers of medications taken (OR 1.24, 95% CI 1.04, 1.48). Receipt of government benefits was associated with medication non-adherence (OR 0.06, 95% CI 0.01, 0.51). Modifiable factors such as the number of medications and the patient-healthcare team relationship appear to play a role in medication adherence. [ABSTRACT FROM AUTHOR]

Purpose -- This study aims to evaluate differences between substance dependent men who were arrested for intimate partner violence (IPV) with and without concurrent psychiatric problems. Design/methodology/approach -- In total, 63 participants were randomly assigned to manual-guided group behavioral therapies (cognitive behavioral therapy for substance dependent domestic violence offenders (SADV) or drug counseling (DC)) and assessed across 12 weeks of treatment. Findings -- Despite excluding psychotic disorders and bipolar disorders at baseline, 23 percent of clients reported prior mental health treatment. SADV participants with co-occurring mental health were different than SADV participants without co-occurring mental health symptoms on both baseline and post-treatment time periods. SADV participants with co-occurring mental health symptoms had more pre-treatment impairments, more drug use during treatment, a trend for more problems with aggressive behaviors throughout treatment and significantly more impairments in anger control subscales at post treatment compared to SADV participants without co-occurring mental health symptoms. Practical implications -- The findings suggest the need to target and treat co-occurring psychiatric symptoms and distress among SADV offenders. Perhaps offering clients targeted behavioral or pharmacotherapy adjunctive treatments can help improve treatment outcomes among substance dependent offenders of IPV when mental health problems are present. Originality/value -- This study is one of the first to evaluate differences between substance dependent men arrested for IPV with and without concurrent psychiatric problems. It shows that men who are violent toward their partners tend to have a co-occurring problem with addiction, yet little is known about differences between substance dependent male offenders who have dual mental health problems. [ABSTRACT FROM AUTHOR]

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