The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV

Objective: The purpose of this study was to examine the relationships between medical mistrust and trust and to determine if these measures differentially predict antiretroviral therapy (ART) medication adherence for African-American adults living with HIV.

Design: A total of 458 HIV positive African-Americans completed a cross-sectional survey.

Main Outcome Measures: Self-reported ART adherence was collected using the visual-analog scale. The Beliefs About Medicines Questionnaire was used to assess medication necessity and concern beliefs.

Results: All measures of medical mistrust and trust were significantly negatively correlated, ranging from r = ?.339 to ?.504. Race-based medical mistrust significantly predicted medication necessity and concern beliefs, whereas general medical mistrust only significantly predicted medication concerns. Both measures of trust significantly predicted medication necessity beliefs and medication concerns. Higher levels of race-based medical mistrust predicted lower medication adherence, whereas, neither trust in own physician nor trust in health care provider significantly predicted medication adherence. However, trust in own physician significantly predicted medication necessity beliefs, which predicted medication adherence.

Conclusion: Trust and mistrust are not simply opposites of one another. These findings provide evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health beliefs and behaviours.     

“Changing the Text”: Modeling Council Capacity to Produce Institutionalized Change

Collaboration is a ubiquitous approach to change, but is notoriously difficult and not definitively linked to desirable outcomes. Not surprisingly, the collaboration literature is replete with numerous facilitators and barriers to collaborative efforts. The current study aimed to develop a parsimonious model of factors influencing the success of collaborative efforts both internal and external to the council, including, (a) features of the council environment, (b) intermediate outcomes including the empowerment of members in the council context and the degree to which councils have generated social capital and (c) the extent to which collaborative efforts are occurring in a community context supportive of their aims. In particular, this study examines whether these factors affect the extent to which councils are positioned to achieve institutionalized change, or changes "in the text" that govern front line providers' (e.g., police, advocates) practices in the community response to intimate partner violence. Results suggest that perceived member empowerment, generation of social capital, and supportive community context are the most important predictors of the extent to which councils foster shifts in institutionalized change. Features of the council environment are only indirectly related to the degree to which institutionalized change is ultimately fostered as mediated by the generation of social capital. This suggests that the ability of members to act as change agents and the extent to which those in power support council efforts figure more prominently to facilitate or constrain council efforts than council functioning itself.     

Councils as Empowering Contexts: Mobilizing the Front Line to Foster Systems Change in the Response to Intimate Partner Violence

Collaborative approaches to change are common, and though evidence for their effectiveness is equivocal, there is growing support that councils facilitate desired changes in the systems response to intimate partner violence. Questions remain regarding the specific mechanisms by which this change is facilitated, and recent work has focused on examining the intermediate processes through which councils may produce more distal change. One such mechanism relates to the potential of councils to be empowering contexts for their membership, often comprised of front-line providers and responders. The present study examines what factors are positively related to perceived individual empowerment as an outcome for members, and importantly, considers not only perceived council context, but also the perceived organizational contexts in which each council member is employed. Study findings suggest that both contexts-council and organizational-are important when considering the degree to which members are empowered. Specifically, member participation, council leadership, and supportive council and organizational climates are significantly positively related to the degree to which councils function as empowering contexts. However, the effect of belonging to a council with a supportive climate, characterized in particular by shared power in decision-making, is stronger when members are from high organizational support settings versus low support settings.     

Part 1 behavioral science scores: after a summer psychiatric research clerkship: failure to replicate.

The present study did not replicate Holmes,' et al.'s (1987) findings that medical students who participated in a summer psychiatric research clerkship scored statistically significantly higher than matched controls on the Behavioral Science portion of the National Board of Medical Examiners' Part I Exam. Group ns in this replication were 39 each.     

The influence of gender on the frequency of pain and sedative medication administered to postoperative patients

This study examines whether the frequency of pain and sedative medication administered to postoperative coronary artery bypass graft (CABG) patients differs according to patient gender. It was hypothesized that nurses medicate patients with pain medication more frequently if they are men than if they are women. It was also hypothesized that nurses medicate female patients with sedative medication more frequently than male patients. The hypotheses in this study were based on a review of the literature indicating that health care professionals hold stereotypic views of women as emotionally labile and more apt to exaggerate complaints of pain than men. The medication records of 30 male and 30 female patients between 44–71 years of age, who had undergone recent CABG surgery, were evaluated in this study. Male and female patients were matched on the basis of age, number of grafts completed in surgery, and location of graft donor sites. All data were obtained through the use of medical records to allow for control of patients' current and past medical history. The frequency of pain and sedative medication administered to these patients from 12 hours postop to 72 hours postop was compared. The results revealed that male patients were administered pain medication significantly more frequently than female patients, and that female patients were administered sedative medication significantly more frequently than male patients. Also, patients 61 years or younger received pain medication significantly more frequently than those patients 62 years and over.     

Effects of Patients' Age,Gender, and Depression on Medical Students' Beliefs,Attitudes, Intentions,and Behavior1

This study examines the effects of patient age, gender, and depression on 88 advanced medical students' beliefs, attitudes, intentions, and behavior. Each subject heard an audiotaped patient portrayal. Patient age (32 or 67 years), gender, and depressive symptoms varied in a 2 × 2 × 2 between-subjects factorial design. All of the patients reported the same symptoms except that half of them also presented symptoms of depression. Questionnaires assessed beliefs about the patient's condition, attitudes toward the patient, treatment intentions, and recall of patient information. Expectations of an age bias were not substantiated. Females were rated less seriously ill, less likely to require laboratory tests, and more likely to receive medication than males. Among depressed patients, counseling and reassurance were more likely for females, and a nonpsychiatric consult was more likely for males. Recall of the symptoms presented was better for depressed patients. The implications for medical practice are discussed.     

Intentional and unintentional nonadherence in patients prescribed HAART treatment regimens

The objective was to investigate intentional and unintentional nonadherence to anti-HIV treatment regimens from a decision-making perspective. The participants (n?=?117) being treated with anti-HIV medication completed a questionnaire asking about nonadherence; reasons for and against taking the medication; and medical consultation style. Thirty-three participants (29%) reported intentionally missing or altering doses of medication at least 5% of the time; 59 participants (50%) reported forgetting to take medication at least 5% of the time. Intentional nonadherence was associated with the balance of the perceived benefits and losses of taking medication, and extent to which participants were 'prepared for the effects of the medication'. Unintentional nonadherence was associated with demographic and clinical variables. The research highlights the importance of (i) treating intentional and unintentional nonadherence as separate entities; (ii) assessing individuals' idiosyncratic beliefs and internal logic when considering intentional nonadherence; and (iii) ensuring that individuals feel prepared for the effects of their medications.     

Measuring the effectiveness of psychoeducation on adherence,depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial

Despite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.

     

Reinforcer pathology,probabilistic choice,and medication adherence in patients with multiple sclerosis

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).     

The Revival of Orthodox Mission in New Borders and the Holy and Great Council of the Orthodox Church

One of the critical issues emphasized at the Holy and Great Council of the Orthodox Church in Crete in 2016 was that of the witness of Orthodoxy in the modern world, as expressed in the Message and Encyclical of the council, and in the council document on the Mission of the Orthodox Church. This paper traces the revival of foreign mission and witness within the Orthodox Church since the late 1950s and how it came to fruition at the council in Crete.     

Risk factors for infant attrition and low engagement in experiments and free-play

Forty-three 2-month-old infants participated with their mothers in a laboratory study of factors associated with variations in infants' attrition and levels of attention/engagement in a cognitive-perceptual experiment, and in free-play with their mothers. Increased risk of attrition from the experiment was strongly associated with analgesic medication having been administered during labor and with more restricted maternal perceptions of infants' capacities. Attrition rates and levels of engagement varied independently, showing different patterns of association with explanatory variables. Infants' levels of engagement in the experiment and in free-play were correlated across settings and low levels were associated with a lack of maternal identification with the foetus during early pregnancy and more limited maternal perceptions of their infants' capacities, but were not associated with analgesic medication during labor.     

Impact of Institutional Review Boards on cancer research

The concepts of informed consent and surveillance of human research designed to protect human subjects is commendable. The regulations of the Institutional Review Board (IRB) are having a major impact on clinical cancer research. There is greater administrative time needed of the investigator, the mechanisms of patient care have become cumbersome and some patients reject optional medical management that could be life saving. IRB regulations must be flexible to meet the needs of human subjects as well as those of the clinical investigator.     

A commentary on Dr. Kennedy's perception of the impact of Institutional Review Boards on cancer research

The Institutional Review Board is a committee of the institution responsible for carrying out the institution's responsibilities for the protection of human research subjects. Since it is a local committee, most of the complaints about the IRB can be resolved locally provided it is borne in mind that the IRB is the champion not only of the human research subject but also of the investigator. National or regional cooperative research protocols present problems that are not insurmountable.     

Reactivity to Stress: When Does a History of Medical Adversity Foster Resilience Versus Vulnerability?

Young adults with (or without) a history of medical or physical disorders (MPDs) were exposed to repeated laboratory stress. The effects of MPD status on habituation (as measured by changing levels of cortisol) were found to be moderated by the extent to which respondents reported “attachment feelings” in their relationships (as measured by the Social Provisions Scale). Students in the MPD group who reported attachment feelings showed (a) cortisol increases during their first exposure to a laboratory stressor; and (b) cortisol decreases during a second exposure to the same stressor 1 week later. No equivalent benefit was found for students who lacked this medical history. Findings suggest the extent to which medical adversity—under the right interpersonal circumstances—promotes resilience.     

The Holy and Great Council – Communication of the Church Message

The article examines the impressions of observers about the Holy and Great Council in Crete in 2016 that have been most discussed, above all a strong competition between national churches and their leaders, and an enormous discrepancy between the agendas seen as urgent by hierarchs and by laypeople. While the fathers of the council based their work on categories of late antiquity, communicating a lack of interest about the “secular” reality, laypeople have stressed a hermeneutic rethinking of Byzantine identity, of Orthodox hermeneutics, of making people aware of and interpreting the historical heritage of Orthodoxy. On the one hand, observers received a message of a lack not only of Orthodox unity, but even of the interpretation of what that unity should consist of. On the other hand, the council unintentionally mobilized Orthodox people worldwide for unity, gathering at the first congress of the International Orthodox Theological Association three years after the council.     

Improving self-report measures of non-adherence to HIV medications

The aim of this article is to clarify what factors should be measured to assess non-adherence to an antiretroviral medication regimen among individuals with the Human Immunodeficiency Virus (HIV). In order to consider a patient as non-adherent, a clear operational definition of medication non-adherence should be formulated. This definition should specify the medication to be taken, the medical advice to be followed as well as the behaviors a patient should adopt in a given period of time. Techniques aimed at reducing the influence of several potential biases in self-report questionnaires, such as forgetfulness and social desirability, are also reviewed.     

Is there a chaplain in your clinic?

As medical care continues to move outside the hospitals, clients with spiritual needs are more often to be found in clinics and doctors' offices than inpatient settings. Chaplains in partnership with physicians can contribute to healing in outpatient centers. A study of one group of clinic patients indicates that an outpatient setting may be a better place to address spiritual needs than a hospital setting. Pastoral interventions are acceptable to many clients, who according to statistics are already using alternative therapies to augment traditional medical care. Paul A. Mandziuk, M. Div., a priest of the Missionaries of La Salette, is a chaplain at Saint Louis University Health Sciences Center in St. Louis, MO, and serves on the leadership council of the National Association of Catholic Chaplains.     

Measuring Non-Economic Quality of Life on a Sub-National Level: A Case Study of New Zealand

Most research on non-economic quality of life has a national focus and/or uses subjective measures. This paper makes use of a multitude of demographic and geographic variables to construct objective indices of quality of life. This analysis is applied at the sub-national level for New Zealand for the purpose of rating regional areas on their quality of life over the period of 1986?C2006. This study also makes a contribution to the current quality of life literature by using a regression technique to remove the impact of income levels and therefore focus on the non-economic component of these quality of life indices. Our results show that Taranaki and Nelson are doing much better in terms of their quality of life, and Bay of Plenty and Waikato much worse than expected, given their levels of regional GDP per capita. These results have important policy implications at the regional council level.