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Older adults with memory loss often require assistance from caregivers to manage their medications. This study examined the efficacy of a problem-solving-based intervention focused on caregiver medication management, problem solving, self-efficacy, and daily hassles. Caregiver health-related quality of life (HRQoL) and patient health care utilization were secondary outcomes. Totally, 83 patients (age 79.9±8.8 years) and their informal caregivers (age 66.9±12 years, female 69.9%, White 85.5%) were randomized; data collection occurred at baseline, 8, 16, and 24 weeks. Linear mixed modeling showed significant decreases in medication deficiencies which were sustained over time. No significant changes in caregiver problem solving, daily hassles, or patient health care utilization occurred between groups or over time. In addition, caregiver self-efficacy and mental HRQoL decreased in both groups. Physical HRQoL decreased in the intervention group, yet increased in the usual care group. Future research should investigate these outcomes in larger and more diverse samples. [ABSTRACT FROM AUTHOR]

The advancement of research from basic science discovery to clinical application requires the extensive collaboration of individuals from multiple disciplines, therefore the ability to work as an effective interprofessional team is essential for researchers in clinical and translational science (CTS). Courses that build interprofessional skills are a key component in CTS education, but the development of these courses poses numerous administrative and educational challenges. This paper describes the processes of designing, implementing, and evaluating an innovative graduate-level course that combines online lectures and in-class facilitated group discussions to promote interprofessional interactions. The course offers students the opportunity to interact with and learn from individuals in a variety of disciplines, and it requires students to engage in interprofessional group work to meet the course objectives. During the past 4 years, 96 students from the schools of medicine, pharmacy, nursing, public health, and health and rehabilitation sciences at a large urban university have completed the course. The course has been well-received, with 87% of students rating its overall quality as excellent, good, or satisfactory. The course offers educators a model to teach graduate students the skills that are essential for becoming effective CTS researchers. Clin Trans Sci 2012; Volume #: 1-7 [ABSTRACT FROM AUTHOR]

Purpose: Strict adherence to HIV medications is critical to ensure long-term disease control, and adherence interventions that are possible in a clinic setting with limited resources are needed. Data sources: This randomized controlled pilot study tested an adherence intervention guided by the Information-Motivation-Behavioral Skills (IMB) model. The intervention included HIV education, a peer video, motivational interviewing, and attention to behavioral skills including communication with providers and adherence-enhancing devices. Dependent variables included 3-4 week adherence recall, medication refill rate, changes in IMB subscale scores, appointment attendance, and HIV-associated laboratory findings. Seventy-three individuals starting or restarting antiretroviral therapy were enrolled and 56 were randomized. Conclusions: Improvements were seen in most outcomes, with small to moderate effect sizes, but the study was not powered to show statistical significance. Threats to power included a 51% attrition rate, resulting mostly from loss to clinical care or prolonged gaps in care. Implications for practice: A telephone-based intervention to improve HIV medication adherence shows promise. Further study is needed with greater attention to retention in care. [ABSTRACT FROM AUTHOR]

erlen j.a., cha e.s., kim k.h., caruthers d. & sereika s.m. (2010) The HIV Medication Taking Self-efficacy Scale: psychometric evaluation. Journal of Advanced Nursing 66(11), 2560-2572. Aim. This paper is a report of an examination of the psychometric properties of the HIV Medication Taking Self-efficacy Scale. Background. Self-efficacy is a critically important component of strategies to improve HIV medication-taking; however, valid and reliable tools for assessing HIV medication-taking self-efficacy are limited. Method. We used a cross-sectional, correlational design. Between 2003 and 2007, 326 participants were recruited from sites in Pennsylvania and Ohio in the United States of America. Six self-report questionnaires administered at baseline and 12 weeks later during 'Improving Adherence to Antiretroviral Therapy' were used to examine the variables of interest. Means and variances, reliability, criterion, and construct validity of the HIV Medication Taking Self-efficacy Scale were assessed. Findings. Participants reported high self-confidence in their ability to carry out specific medication-related tasks (mean = 8·31) and in the medication's ability to effect good outcomes (mean = 8·56). The HIV Medication Taking Self-efficacy Scale and subscales showed excellent reliability (α = 0·93∼0·94). Criterion validity was well-established by examining the relationships between the HIV Medication Taking Self-efficacy Scale and selected physiological and psychological factors, and self-reported medication adherence ( r = −0·20∼0·58). A two-factor model with a correlation between self-efficacy belief and outcome expectancy fitted the data well (model χ2 = 3871·95, d.f. = 325, P < 001; CFA = 0·96; RMSEA = 0·046). Conclusion. The HIV Medication Taking Self-efficacy Scale is a psychometrically sound measure of medication-taking self-efficacy for use by researchers and clinicians with people with HIV. The findings offer insight into the development of interventions to promote self-efficacy and medication adherence in persons with HIV. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Adherence to treatment for chronic illnesses, including HIV disease, is a complex process, and needs practical interventions in poorly resourced clinic settings. Methods: This study tested the feasibility of an adherence intervention in 73 HIV-infected individuals in a Deep South public clinic based on Fisher & Fisher''s Information-Motivation-Behavioral Skills Model. Results: There was high baseline adherence and unexpectedly high clinic attrition, and 27% of the intervention group received less than one-quarter of the planned intervention contacts. Refill rate was the adherence measure that correlated best with HIV viral load and CD4 count, and there was poor use of electronic adherence monitoring (MEMS). Interviewed individuals expressed positive feelings about audio-supported computer-assisted survey instruments (ACASI) and the intervention support. Conclusions: This process evaluation showed feasible study components in this population and setting. Lessons learned included: (1) clinic retention is an important part of adherence; (2) telephone interventions may need to add additional technology and flexibility to maximize dose; (3) ongoing fidelity monitoring is important with motivational interviewing; (4) refill rate was the most accurate adherence assessment; (5) MEMS was not well-accepted; (6) ACASI was easily used in this population; and (7) individuals appreciated adherence support from a consistent caring individual. [Copyright &y& Elsevier]

Abstract: Background: To date, only a few studies have examined the mediating role of self-efficacy on the relationship between depressive symptoms or perceived social support and medication adherence in persons with HIV. Objectives: The purpose of this study was to examine the impact of perceived social support, depressive symptoms and medication-taking self-efficacy on self-reported medication adherence in persons with HIV. A proposed comprehensive model included three mediation hypotheses in order to examine the mediating roles of medication-taking self-efficacy and depressive symptoms. Method: Baseline data from “Adherence to Protease Inhibitors” were used. The 215 persons with HIV aged 19–61 (mean=40.7, S.D.=7.58) were recruited from multiple sites in Pittsburgh, PA (USA) and through self-referral. The participants were assessed using the Beck Depression Inventory, Interpersonal Support Evaluation List, the Medication Taking Self-Efficacy Scale, and the modified Morisky Self-report Medication Taking Scale. Structural equation modeling (EQS version 6.1) was used. The Satorra–Bentler Scaled χ 2 test statistics (S–B χ 2), Comparative Fit Index (CFI), and the Standardized Root Mean Squared Residual (SRMR) were used to assess the fit of a comprehensive model including three mediation hypotheses. Results: A comprehensive model with the three hypotheses showed a good model fit (S–B χ 2 (24, N=215)=69.06, p<.001; CFI=.95; SRMR=.057). Medication adherence self-efficacy fully mediated the prediction of self-reported medication adherence by perceived social support and depressive symptoms. Depressive symptoms partially mediated the prediction of medication-taking self-efficacy by perceived social support. Conclusions: The findings of this study provide researchers with increased understanding of the mediating role of medication-taking self-efficacy beliefs between selected psychological variables and self-reported medication adherence in persons with HIV. Future studies need to test the moderating effect of gender, ethnicity and risk factors for HIV on this model and the intervention effect of self-efficacy beliefs using longitudinal data. [Copyright &y& Elsevier]

The late 1990s saw a decrease in the total number of new cases of HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome). However, data often do not reflect the increased incidence of HIV in women, particularly women from minority groups. The purposes of this clinical review are to address the disease susceptibility and disease manifestations of HIV in women, and to discuss selected barriers to adherence to antiretroviral medications such as stigma, social support, and depression. [ABSTRACT FROM AUTHOR]

sok s.r., erlen j.a. & kim k.b. (2003) Journal of Advanced Nursing 44(4), 375–384 Effects of acupuncture therapy on insomnia Acupuncture therapy, commonly used in clinical practice in oriental cultures, has the potential to produce a positive effect with patients experiencing insomnia. The purposes of this systematic review were: (1) to assess the trends across intervention studies using acupuncture for insomnia from 1975 to 2002, (2) to examine dependent variables, and (3) to evaluate the effects of acupuncture therapy on insomnia in older people. Data were collected from November 2001 to January 2003. A wide range of electronic databases was searched using the keywords ‘insomnia’, ‘acupuncture’ and ‘experimental design’. Papers were included if they were published in the English language between 1975 and 2002 and described an experimental study using acupuncture therapy to treat insomnia. Eleven reports met these criteria. Most of the studies had been conducted since 1990. The findings showed that the first author was usually a Chinese medical doctor ( n = 9) employed in a traditional department of medicine. Most of the papers were published in two journals: International Journal of Clinical Acupuncture and Journal of Traditional Chinese Medicine. Data were limited because of the small number of studies available. Half the studies had small samples (50 subjects or fewer), which were composed mainly of older women who had a variable duration of insomnia from 3 days to 34 years. The main method used to assess outcomes was questionnaire. All the studies reported statistically significant positive results. The results of this review suggest that acupuncture may be an effective intervention for the relief of insomnia. Further research, using a randomized clinical trial design, are necessary to determine the effectiveness of acupuncture. More work is also needed to promote the long-term therapeutic effects of acupuncture and to compare it with other therapies for insomnia. [ABSTRACT FROM AUTHOR]

The overall purpose of this qualitative study was to describe how patients with AIDS (PWAs) transcend the emotional and physical suffering of their illness. Content analysis of the interviews of 5 PWAs resulted in 3 main themes: creating a meaningful life pattern, connectedness, and self-care. The results of this study provide presumptive evidence that PWAs can transcend the suffering associated with a life-threatening illness and live meaningful and productive lives. Nurses who anticipate actual and potential growth in PWAs will be able to validate such experiences and feelings and encourage further development. [ABSTRACT FROM AUTHOR]

People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure. [ABSTRACT FROM AUTHOR]

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders. [ABSTRACT FROM AUTHOR]

Asking children for their opinions about and input into treatment decisions is an idea whose time has come. One way to implement this notion with school-aged children and adolescents is through the Participation in Treatment Decisions Model, This model is based on a child's rights and recognizes the varying levels of cognitive development and competency in children. Health professionals have a responsibility to be advocates for child patients, to protect their interests, values, and rights, and to include them in decisions affecting their health. [ABSTRACT FROM AUTHOR]

Deals with a study which examined nurses' experience in influencing ethical decisions related to patient care management. Background to the study; Study design and method; Perceptions of powerlessness; Discussion.

The purpose of this study was to characterize, from multiple professional perspectives, current management approaches and systems of care for long-term ventilator-dependent patients. This study was preliminary in nature and served to generate questions to be explored with subsequent research. A focus group methodology was used. Three focus sessions were held, with participants representing nursing, social services, and respiratory therapy. Field notes were recorded by two independent observers. The primary themes arising from the narrative data were: (i) caregiver impact, (ii) system barriers to appropriate care, (iii) communication difficulties among professionals and between patients and professionals, (iv) ethical concerns, and (v) patient characteristics that influence medical management and patient outcomes. Implications include the need for systematic research regarding caregiver impact, ethical practice of health care professionals, and the epidemiology of ventilator dependency, as well as evaluative studies of different system approaches to caring for these patients. [ABSTRACT FROM AUTHOR]

Focuses on the attention taken by health care professionals on the possibility of using anencephalic infants as a source of organs for transplantation. Ability of anencephalic infants to maintain the vital body functions; Suggestion of a legislative action for the possibility of organ donation from infants; Requirement of the different type of treatment of infants after birth; Support of the public for organ donations.

The high prevalence of chronic illnesses in South Asian Indian immigrant women underscores the need for identifying factors that could influence their PA. The purpose of this qualitative study was to examine the perspectives of South Asian Indian immigrant women related to barriers to and motives for lifestyle PA within the PA Framework for South Asian Indian Immigrants. Forty women participated in focus groups that were conducted in English and Hindi. Focus group questions were open-ended and semistructured. Transcribed and de-identified audiotaped sessions were coded and analyzed using Atlas.ti software. Role expectation was a core theme for barriers with four subthemes: lack of time, loss of interest, diminished social support, and environmental constraints. Self-motivation was a core theme for motives with three subthemes: optimal physical and psychological health, emphasis on external beauty, and strong social support. Future PA interventions need to target these culturally sensitive factors. [ABSTRACT FROM AUTHOR]

Background/Purpose: Limited research addresses health literacy among informal caregivers who manage medications for community-dwelling persons experiencing memory loss. Health literacy is an important concept when providing interventions to assist informal caregivers with medication management. This study used the Ability, Skill and Knowledge (ASK) Model to characterize health literacy in family caregivers of community-dwelling persons with memory loss and examine relationships between health literacy and caregivers' demographics, cognitive abilities, academic skills, and medication knowledge. Methods: We used baseline data from a randomized controlled trial of a problem solving intervention to improve caregiver's medication management. Instruments included a sociodemographic tool, the Newest Vital Sign (health literacy), the Blessed Orientation-Memory-Concentration Test (global cognition), Letter-Number Sequencing (working memory), Trail Making Test Part B (executive function), and the Medication Management Instrument for Deficiencies in the Elderly (medication knowledge). Descriptive statistics, correlations, and linear regression were used for data analysis. Results: Our sample of 91 caregivers included primarily women (70%; n=64) who were white (85%; n=77) with an average (±SD) age of 67.4 (±11.8) years. The average years of education was 14.9 (±3.3); their average number of comorbidities was 6.9 (±3.6). The average health literacy score was 4.02 (±1.8) indicating adequate literacy; 38% (n=35) had scores suggesting limited health literacy. Health literacy was negatively associated with age (r=-.40; p<.001), global cognitive functioning (r=-.54, p<.001), and executive function (r=-.34, p=.001) and was positively associated with education (r=.37; p<.001), working memory (r=.28, p=.007), and medication knowledge (r=.25, p=.020). Regression analysis showed that health literacy was explained by age (b=-.065, p=.001), global cognitive functioning (b=-.266, p<.001), working memory (b=.219, p=.005), and academic ability/education years (b=.121, p=.008). Conclusions/Implications: Findings suggest that health literacy could be characterized by the constructs of cognitive ability and academic skill of the ASK Model. However, medication knowledge may not independently explain caregiver's health literacy. Age seems to be an important factor in the assessment of health literacy. Assessing health literacy provides an important bridge when designing interventions to improve caregiver medication management. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Moral Reckoning in Nursing," by Alvita K. Nathaniel. Nathaniel gave the nurses an opportunity to recount a past troubling experience within a safe environment and to tell the story to someone who was definitely interested in what was being said. She analyzes moral distress and considers both what precedes the distress and its aftermath rather than focusing solely on the concept of moral distress. The process of moral reckoning aids in understanding what is occurring as nurses live with the troubling situations.

Purpose: The purpose of this secondary analysis was to test Ferrans et al.'s (J Nurs Scholarsh 37(4):336-342, 2005) revised model of health-related quality of life (HRQoL) (2005) modified from the Wilson and Cleary (J Am Med Assoc 273(1):59-65, 1995) model on women living with HIV. The primary aim was to test this model, examining the relations among the five central components (biological function, symptoms, functional status, general health perceptions, and HRQoL). The secondary aim was to explore the individual (age, children, race, marital status, education) and environmental (HIV-related stigma, social support) characteristics that may impact the main components of the model.Methods: This study employed a cross-sectional correlational design using baseline data from 178 women living with HIV/AIDS who participated in one of the two independent randomized controlled trials designed to enhance HIV medication adherence. Path analysis using structural equation modeling was used to examine the hypothesized multivariate relations proposed in the revised Wilson and Cleary (J Am Med Assoc 273(1):59-65, 1995) model of HRQoL.Results: While the revised model did not fit, exploratory post hoc modified models with a path from depressive symptoms to overall general health had an adequate model fit. Women with lower depressive symptoms (r = -.457, p < .01), lower HIV-related stigma (r = -.462, p < .01), higher social support (r = .413, p < .01), higher physical functioning (r = .350, p < .01), and higher general health perceptions (r = .537, p < .01) had higher overall HRQoL.Conclusions: The results of this study have the potential to assist healthcare professionals in improving HRQoL for women living with HIV/AIDS. [ABSTRACT FROM AUTHOR]

The article discusses lessons learned from the Warm Autopsy Program at the Dorothy O. & Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh in Pennsylvania. The idea for the program was planned after a support group meeting, where one of the patients with idiopathic pulmonary fibrosis wanted to donate his lungs to the program for research. As the support group has grown, the principles of honesty and confidentiality are a mainstay of the meetings.

Presents a letter to the editor about the nursing students.

Introduces the September 2003 issue of the journal "Quality of Life Research." Nature of health related issues that need to be taken care during chronic illness; Topics covered in this issue; Importance of exercise to maintain a healthy life.

colbert a.m., sereika s.m. & erlen j.a. (2012) Functional health literacy, medication-taking self-efficacy and adherence to antiretroviral therapy. Journal of Advanced Nursing 69(2), 295-304. doi: 10.1111/j.1365-2648.2012.06007.x Abstract Aims. To report a study of the relationship between functional health literacy and medication adherence, as mediated by medication-taking self-efficacy, while controlling for the effect of key demographic variables (such as race, income and level of education). Background. Medication adherence is critical to successful HIV/AIDS self-management. Despite simplified regimens and the availability of tools to assist with medication-taking, adherence remains a challenge for many people living with HIV/AIDS. Design. Cross-sectional, secondary analysis. Methods. Data for this study of 302 adults living with HIV/AIDS who were taking antiretroviral medications were collected from January 2004-December 2007. Medication adherence was measured using electronic event monitors. Bivariate analyses and stepwise regression were conducted to examine the associations among functional health literacy, medication-taking self-efficacy and HIV medication adherence. Results. Overall, functional health literacy was much higher than expected; however, adherence in this sample was sub-optimal. Higher medication-taking self-efficacy was associated with higher medication adherence; however, functional health literacy was not significantly related to either medication adherence or self-efficacy beliefs. Hence, medication-taking self-efficacy did not mediate the relationship between functional health literacy and medication adherence. Conclusions. Medication adherence continues to be an issue for people living with HIV/AIDS. Additional research is needed to understand the disparate findings related to functional health literacy and medication adherence in this and other studies examining this association. [ABSTRACT FROM AUTHOR]

Purpose: The proposed dementia precursor state of mild cognitive impairment is emerging as a primary target of aging research. Yet, little is known about the subjective experience of living with a diagnosis of mild cognitive impairment. This study examines, from the patient's perspective, the experience of living with and making sense of the diagnosis. Design and Methods: We recruited 12 older adults with amnestic or nonamnestic mild cognitive impairment from a university-based memory disorders clinic. We conducted in-home, semistructured interviews in order to elicit rich descriptions of the personal experience of having mild cognitive impairment. We used the qualitative method of grounded theory to analyze narrative data. Results: Understanding and coming to terms with the syndrome, or assigning meaning, constituted a fundamental aspect of living with a diagnosis of mild cognitive impairment. This process comprised interrelated emotional and cognitive dimensions. Participants employed a range of positive, neutral, and negative phrasing in order to depict their emotional reactions to receiving a diagnosis. Cognitive representations of mild cognitive impairment included both prognosis-focused and face-value appraisals. Expectations of normal aging, personal experience with dementia, and concurrent health problems were key contextual factors that provided the backdrop against which participants assigned meaning to a diagnosis of mild cognitive impairment. Implications: Clinicians who disclose diagnoses of mild cognitive impairment need to be mindful of the potential For varying interpretations of the information that is conveyed. Future research needs to include systematic, longitudinal investigations of illness representation and its impact on health behaviors among individuals with mild cognitive impairment. [ABSTRACT FROM AUTHOR]

Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals’ medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals’ situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidimensional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Background: Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome. Objectives: Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes. Methods: A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined. Results: Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome. Discussion: Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications. [ABSTRACT FROM AUTHOR]

Background: Understanding caregiver's perceptions of their family member's memory loss is a necessary step in planning nursing interventions to detect and address caregiver burden. Objective: The purpose of this study was to characterize caregivers' perceptions of their family members' memory loss and identify potential correlates within Leventhal's common sense model (CSM). Methods: This secondary analysis used baseline data from a larger randomized controlled trial. Patients with memory loss and their caregivers (N = 83 dyads) from the community were included. The adapted Brief Illness Perception Questionnaire (BIPQ) assessed caregivers' illness perceptions. Eight additional instruments measured correlates within the CSM. Responses were described; multiple linear regression was used to predict BIPQ dimension scores, and logistic regression was used to predict dichotomized BIPQ scores. Results: Most caregivers were female, White, and spouses of the patients; they reported a range of perceptions on the nine BIPQ dimensions. Patients' cognitive function consistently emerged as a significant correlate of caregivers' illness perceptions, explaining the most variance in caregivers' perceived consequences, identity, and treatment control (p < .01). Caregivers' reactions to patients' behavioral symptoms and caregivers' trait anxiety were associated with perceived illness coherence (p < .01). Caregivers with higher severity of daily hassles and White caregivers perceived that their family members' memory loss would last longer (p < .001). Discussion: Caregivers' perceptionsof family members' memory loss varied; distinct dimensions of caregivers' illness perception were associated with a range of clinical and psychosocial factors. This exploratory study demonstrates the complexity of applying the CSM to caregivers of persons with memory loss. [ABSTRACT FROM AUTHOR]

Aim To examine the mediating role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in Korean adults. Background Recent evidence suggests that higher levels of social support are associated with improved medication adherence and self-care activities; however, the role of social support on the relationship of depressive symptoms to medication adherence and self-care activities is less well understood. Design A cross-sectional survey. Methods The data were collected from 311 Korean adults with type 2 diabetes who were taking hypoglycaemic agents in the period 2012-2013. Depressive symptoms, social support, medication adherence and self-care activities were assessed using structured questionnaires. Multiple regression analysis with adjustment for covariates and the Sobel test were used to examine the mediating effect of social support on the relationship of depressive symptoms to medication adherence and self-care activities. Results There were statistically significant differences by subgroups with and without depressive symptoms in social support, medication adherence and self-care activities of diet, physical activity and stress management. The Sobel test confirmed that social support mediated the effect of depressive symptoms on medication adherence and self-care activities of diet, physical activity and stress management. Conclusion The evidence from this study suggests that social support-enhancing interventions that also manage depressive symptoms may be more timely and effective than interventions that target depressive symptoms alone in promoting adherence to medication adherence and self-care activities in this population. [ABSTRACT FROM AUTHOR]

Caring for an older adult with memory loss is stressful. Caregiver stress could produce negative outcomes such as depression. Previous research is limited in examining multiple intermediate pathways from caregiver stress to depressive symptoms. This study addresses this limitation by examining the role of self-efficacy, social support, and problem solving in mediating the relationships between caregiver stressors and depressive symptoms. Using a sample of 91 family caregivers, we tested simultaneously multiple mediators between caregiver stressors and depression. Results indicate that self-efficacy mediated the pathway from daily hassles to depression. Findings point to the importance of improving self-efficacy in psychosocial interventions for caregivers of older adults with memory loss. [ABSTRACT FROM AUTHOR]

Caring for an older adult with memory loss is stressful. Caregiver stress could produce negative outcomes such as depression. Previous research is limited in examining multiple intermediate pathways from caregiver stress to depressive symptoms. This study addresses this limitation by examining the role of self-efficacy, social support, and problem solving in mediating the relationships between caregiver stressors and depressive symptoms. Using a sample of 91 family caregivers, we tested simultaneously multiple mediators between caregiver stressors and depression. Results indicate that self-efficacy mediated the pathway from daily hassles to depression. Findings point to the importance of improving self-efficacy in psychosocial interventions for caregivers of older adults with memory loss. [ABSTRACT FROM AUTHOR]

To use electronic drug monitoring to determine if adherence to HIV antiretroviral therapy (ART) changes over time, whether changes are linear, and how the declines vary by study.We conducted a longitudinal study of pooled data from 11 different studies of HIV-infected adults using ART. The main outcome was ART adherence (percent of prescribed doses taken) measured by electronic drug monitoring. We modeled and compared changes in adherence over time using repeated measures linear mixed effects models and generalized additive mixed models (GAMMs). Indicator variables were used to examine the impact of individual studies, and the variation across studies was evaluated using study-specific parameter estimates calculated by using interaction terms of study and time.The mean age of the subjects was 41 years, 35% were female, most had high school education or less, and 46% were African American. In GAMMs, adherence declined over time. The GAMMs further suggested that the decline was nonlinear, and in both sets of models, there was considerable study-to-study variability in how adherence changed over time.Findings may not be generalizable to non-US populations or to patients not in clinical studies.Although overall ART adherence declined with time, not all studies showed declines, and a number of patterns of change were seen. Studies that identify clinical and organizational factors associated with these different patterns are needed. Models of changes in adherence with time should take account of possible nonlinear effects. [ABSTRACT FROM AUTHOR]

Persons living with human immunodeficiency virus (HIV) are living longer; therefore, they are more likely to suffer significant morbidity due to potentially treatable liver diseases. Clinical evidence suggests that the growing number of individuals living with HIV and liver disease may have a poorer health-related quality of life (HRQOL) than persons living with HIV who do not have comorbid liver disease. Thus, this study examined the multiple components of HRQOL by testing Wilson and Cleary's model in a sample of 532 individuals (305 persons with HIV and 227 persons living with HIV and liver disease) using structural equation modeling. The model components include biological/physiological factors (HIV viral load, CD4 counts), symptom status (Beck Depression Inventory II and the Medical Outcomes Study HIV Health Survey (MOS-HIV) mental function), functional status (missed appointments and MOS-HIV physical function), general health perceptions (perceived burden visual analogue scale and MOS-HIV health transition), and overall quality of life (QOL) (Satisfaction with Life Scale and MOS-HIV overall QOL). The Wilson and Cleary model was found to be useful in linking clinical indicators to patient-related outcomes. The findings provide the foundation for development and future testing of targeted biobehavioral nursing interventions to improve HRQOL in persons living with HIV and liver disease. [ABSTRACT FROM AUTHOR]

The article discusses a study to describe the assessment of fidelity to the structured intervention protocol in an examination of a nurse-delivered telephone intervention designed to improve medication adherence for individuals with HIV/AIDS. It offers details related to fidelity assessment that involved random selection and review of the audiorecorded intervention sessions, stratified by interventionist, and the use of visual analog scales. Also discussed is the result of the study.

Objective: Adherence to treatment for chronic illnesses, including HIV disease, is a complex process, and needs practical interventions in poorly resourced clinic settings.Methods: This study tested the feasibility of an adherence intervention in 73 HIV-infected individuals in a Deep South public clinic based on Fisher & Fisher's Information-Motivation-Behavioral Skills Model.Results: There was high baseline adherence and unexpectedly high clinic attrition, and 27% of the intervention group received less than one-quarter of the planned intervention contacts. Refill rate was the adherence measure that correlated best with HIV viral load and CD4 count, and there was poor use of electronic adherence monitoring (MEMS). Interviewed individuals expressed positive feelings about audio-supported computer-assisted survey instruments (ACASI) and the intervention support.Conclusions: This process evaluation showed feasible study components in this population and setting. Lessons learned included: (1) clinic retention is an important part of adherence; (2) telephone interventions may need to add additional technology and flexibility to maximize dose; (3) ongoing fidelity monitoring is important with motivational interviewing; (4) refill rate was the most accurate adherence assessment; (5) MEMS was not well-accepted; (6) ACASI was easily used in this population; and (7) individuals appreciated adherence support from a consistent caring individual. [ABSTRACT FROM AUTHOR]

Objective: To examine the relation between problem drinking and medication adherence among persons with HIV infection.Design: Cross-sectional survey.Setting/participants: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998.Measurements and Main Results: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001).Conclusion: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence. [ABSTRACT FROM AUTHOR]