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This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 years or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using the Medication Event Monitoring System. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component.

This project examined patterns, predictors, and outcomes of medication adherence in a convenience sample of 37 renal transplant recipients aged 55 years or older in a Mid-Southern U.S. facility using an exploratory, descriptive, longitudinal design. Electronic monitoring was conducted for 12 months using the Medication Event Monitoring System. An alarming 86% of the participants were nonadherent with medications. Four clusters of medication taking and timing patterns were identified with evening doses presenting particular challenges. Depression, self-efficacy, social support, and medication side effects did not predict medication adherence. There was no significant difference in medication adherence scores between those with and without infections. Medication adherence pattern data from electronic monitoring provides an opportunity for health care professionals to move away from blaming the patient by attempting to identify predictors for medication nonadherence. Medication dose taking and timing patterns could be explored with patients so that medication adherence interventions could target specific patient patterns.

Context The contribution of social support networks to the recovery of transplant recipients is an important assessment in measuring improved physical and psychosocial well-being. Social support networks are described by structure, type, and function. Objectives (1) To describe the levels of structure (size, formal and informal support), type (concrete, emotional, and informational), and function (criticalness, direction, closeness, frequency, and duration) of the social support network and (2) to examine the relationships between individual characteristics of sex, race, and social class and social support networks. Methods This exploratory-descriptive study was done in a Mid-south transplant center. A total of 258 kidney, liver, and pancreas transplant recipients participated, 61% of whom were less than 50 years old. Instruments included a demographic questionnaire, the social support network pie chart, and the social support network grid. Descriptive statistics and analysis of variance were used with a .05 significance level. Results The social support network comprised extended family (67%), with a mean of 13.68 members. Emotional support was the most prevalent type of support reported. The mean (SD) duration of support was 7.9 (4.9) years. Sex, race, and social class had no main relationships with structure and type of support. However, women had a main effect with closeness (F=4.98, P

Improved quality of life and physical functioning among renal transplant recipients have been documented; however, little of the literature has addressed the effects of transplantation on family caregivers. The purpose of this exploratory descriptive study was to characterize the level of subjective burden, quality of life, and self-rated health of caregivers who assist family members prior to transplantation as well as at 6 months following. The study sample included 19 caregivers of 19 renal transplant recipients. In general, caregiver burden, quality of life, and self-rated health did not improve following patients' transplants. In addition, 9 of 19 family caregivers reported increased burden. Because much of healthcare is family-based and greater reliance on family support seems inevitable, further studies are needed to examine the impact of transplantation on the family as well as the impact of the family on patients' posttransplant outcomes.

This descriptive, qualitative study examines manifestations of the Chronic Illness and Recovery models among clinical transplant coordinators. Data collected through focused group interviews revealed that the Chronic Illness model fosters patient dependency, education about the illness itself, a perception that transplantation does not change the chronic nature of illness, a view of patients as socioeconomically disadvantaged and dependent on the transplant center, and the use of reactive approaches to care. In contrast, the Recovery model encourages patient independence, limits coordinators' protective feelings toward patients, provides education for life tasks, perceives patients as socioeconomically advantaged people capable of managing their own lives, and conducts patient care in a proactive manner.

This study evaluated older renal transplant recipients’ perceptions of electronic medication monitoring and the influence of these perceptions on medication adherence. A sample of 73 older adult renal transplant recipients who used the Medication Event Monitoring System (MEMS®) TrackCaps for 12 months provided their perceptions of device use. Participants perceived that the MEMS had a neutral effect on their medication-taking routine (65%), believed the MEMS was practical (56%), and could not describe any instances in which using the MEMS was difficult (56%). No significant difference in medication adherence was found between those who perceived the MEMS’s influence negatively/neutrally and those who perceived the MEMS positively (p = 0.22). Medication adherence data from older adult renal transplant recipients can be used regardless of their perceptions of the MEMS’s influence on their medication taking without biasing medication adherence data.

Cultural influences on sex differences in clinical characteristics and symptomatology of schizophrenia were studied among 369 schizophrenic patients from the United States and Turkey. Mate schizophrenics were more likely to be single, and were younger than female schizophrenics at onset of symptoms and when first diagnosed, treated and hospitalised in both cultures. Turkish male and female schizophrenics were more ambivalent, inappropriate, "silly", euphoric, depersonalised, dissociated, mute, conceptually disorganised, and exhibiting more flight of ideas and thought paucity than American male and female schizophrenics. Irrelevant thought and stereotypic behaviour were most severe in Turkish male and American female schizophrenics. Hallucinatory behaviour was most intense in Turkish separated, divorced, or widowed female schizophrenics and American married male schizophrenics. Turkish married female and Turkish separated, divorced, or widowed male schizophrenics were most disoriented. Turkish single female schizophrenics were most mute. Turkish separated, divorced, or widowed male schizophrenics showed most intense stupor behaviour.

With advances in medicine and pharmacology, post-transplant quality of life (QoL) has become a major concern of researchers. In social work transplant practice, provision of social support towards QoL warrants attention. The purposes of this study were (1) to describe the social support networks of kidney, liver, and pancreas transplant recipients during the post-transplant phase of their recovery, and (2) to examine the correlations between the types and nature of social support networks and the QoL of these transplant recipients. We conducted an exploratory-descriptive study in a US university's transplant clinic. Instruments were the Social Network Map, Adult Self-Image Scale, Sickness Impact Profile, and Quality of Life Index. Descriptive statistics, and correlation analyses were used with a significance level of .05. We observed correlations between concrete and emotional support, and direction, closeness and duration of support, and QoL. Based on our findings, we discussed implications for research and practice.

Purpose To examine differences in quality of life before transplantation among transplant recipients with respect to a selected set of socioeconomic variables related to household/housing, family social and health history, and availability and use of community resources. Methods An exploratory-descriptive study in a US university's transplant clinic. Sample included 249 kidney, liver, and pancreas transplant recipients aged 18 years or older. Instruments were a socioeconomic data questionnaire, the Sickness Impact Profile, the Adult Self-Image Scale, the Quality of Life Index, and a general quality of life scale. Descriptive statistics and analysis of variance with Bonferroni adjustment were used with a significance level of .05. Effect sizes were estimated. Results Quality of life did not differ significantly for any variable except for the use of private insurance combined with public health insurance. Such coverage was associated with significantly better scores on the psychosocial and total dimensions of the Sickness Impact Profile, indicating better health before transplantation. Conclusion Researchers must first explore why a mix of private and public health insurance is associated with a higher quality of life and second reexamine whether these results occur at other transplant centers. These results also provide direction for social work professionals as they counsel patients in an attempt to help patients achieve a better psychosocial and physical quality of life before transplantation.

Context Quality of life and transplant age are 2 major concerns of professionals and researchers. Both variables are contemplated in transplant allocation decisions as a result of longer graft and patient survival and the likelihood of achieving a reasonably good quality of life for patients of all ages. Studies are warranted to understand if quality of life might serve as a moderating variable to balance question of age and transplant allocations. Objective To determine if there are differences in the pretransplant and posttransplant quality of life of kidney transplant recipients with respect to age. Design, Participants, Setting, and Outcome Measures This study comparatively examined the differences in pretransplant and posttransplant quality of life of kidney transplant recipients in 5 age groups (18–29 years, 30–39, 40–49, 50–59, and older than 60). A sample of 293 patients admitted to a midsouthern US transplant center and selected on a convenience-sampling basis were included in the study. Multiple measures of quality of life were used, including the Quality of Life Index, the Adult Self-Image Scale, and the Sickness Impact Profile. Results Both the pretransplant and posttransplant quality of life of all age groups of kidney transplant recipients were similar, with the exception that the recipients in the age range of 30 to 49 years reported better posttransplant quality of life on the Sickness Impact Profile Psychosocial measure (F = 2.18, P = .02). Conclusions Quality of life outcomes do not appear to favor one age group over another, although psychosocial outcomes may warrant some additional consideration.

Social support can have great influence on health, well-being, and general quality of life To promote awareness of the social network that surrounds each transplant recipient, transplant social workers are now using the Social Network Map as an intervention. Because perceptions of availability and accessibility of support are key elements in the use of social network resources, awakening an individual's awareness of available resources is a significant first step in enhancing social support and, ultimately, quality of life. The Social Network Map is used to establish dialogue regarding individuals' needs and sources of support, and then how the support system can meet those needs. Transplant social workers thus foster active use of those people in transplant recipients' networks who can meet the particular needs recipients identify.

Improved quality of life and physical functioning among renal transplant recipients have been documented; however, little of the literature has addressed the effects of transplantation on family caregivers. The purpose of this exploratory descriptive study was to characterize the level of subjective burden, quality of life, and self-rated health of caregivers who assist family members prior to transplantation as well as at 6 months following. The study sample included 19 caregivers of 19 renal transplant recipients. In general, caregiver burden, quality of life, and self-rated health did not improve following patients' transplants. In addition, 9 of 19 family caregivers reported increased burden. Because much of healthcare is family-based and greater reliance on family support seems inevitable, further studies are needed to examine the impact of transplantation on the family as well as the impact of the family on patients' posttransplant outcomes.

Asian immigrants and refugees are often powerless in American society. Thus client empowerment should be a major goal in working with this population group. Workers should help these clients adapt to their environment without abandoning their ethnic heritage, values, and beliefs.

Over a period of several years, drug studies conducted at the Missouri Institute of Psychiatry and replicated in Turkey suggested that discharge problems of schizophrenic patients in both countries were severe, but diametrically opposed in nature. In Missouri, patients' families frequently were reluctant to take patients home from the hospital; when they did, there were adjustment problems many times ending with readmission; often, discharge could be made only by using community facilities such as halfway houses, nursing or boarding homes, or foster communities. By contrast, in Turkey, doctors encountered problems in keeping patients in hospital long enough for them to achieve maximum improvement; a review of their studies showed an attrition rate in some instances of almost 25%. The apparent clinical reasons given were the families' and patients' wishes for the patient to return home as soon as improvement was noted; and despite doctors' explanations that greater improvement could be achieved, patients eloped or left against medical advice if discharge was denied.