Advances in Patient Adherence to Medical Treatment Regimens: The Emerging Role of Technology in Adherence Monitoring and Management

Adherence is a term used to describe the extent to which an individual's behavior coincides with health‐related instructions or recommendations given by a healthcare provider in the context of a specific disease or disorder. Despite significant advances in biomedical science related to the treatment of disease, the problem of nonadherence remains pervasive and may be aptly described as a global public health concern. The recent proliferation of telemedicine coupled with the ubiquity of personal computers, mobile phones, and other wireless communication devices have, in part, led to the development and implementation of a variety of technology‐based methods used to assess, monitor, and manage adherence. As the chronic illness burden continues to grow, these methods may offer solutions to some of the limitations of traditional means particularly for conditions requiring complex self‐management and lifestyle adjustment. In this article, we briefly review recent advances in adherence monitoring and management including m‐health, home telemonitoring systems, web‐based support (i.e., self‐management websites and virtual support groups), and patient portals and personal health records before concluding with a brief account of some exciting new technologies under development in the context of patient adherence.     

Mentalization-Based Treatment

The concept of mentalizing has captured the interest and imagination of an astonishing range of people—from psychoanalysts to neuroscientists, from child development researchers to geneticists, from existential philosophers to phenomenologists—all of whom seem to have found it useful. According to the Thompson Reuter maintained Web of Science, the use of the term in titles and abstracts of scientific papers increased from 10 to 2,750 between 1991 and 2011. Clinicians in particular have enthusiastically embraced the idea, and have put it to innovative use in their practices. Mentalization-based treatment (MBT)—making mentalizing a core focus of therapy—was initially developed for the treatment of borderline personality disorder (BPD) in routine clinical services delivered in group and individual modalities. Therapy with mentalizing as a central component is currently being developed for treatment of numerous groups, including people with antisocial personality disorder, substance abuse, eating disorders, and at-risk mothers with infants and children (A. Bateman & Fonagy, 2011). It is also being used with families and adolescents, in schools, and in managing social groups (Asen & Fonagy, 2011; Fonagy et al., 2009; Twemlow, Fonagy, & Sacco, 2005a Twemlow, S. W., Fonagy, P. and Sacco, F. C. 2005a. A developmental approach to mentalizing communities: I. A model for social change. Bull. Menninger Clin, 69(4): 265–281. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar], 2005b). In this article, we focus on MBT in the treatment of BPD.     

Creative potential and conceptual tempo in preschool children

The individual stylistic variations of creative potential and conceptual tempo were investigated in preschool children (n = 61; mean age = 56.9 months). The measure used for the conceptual tempo was the Kansas Reflection Impulsivity Scale for Preschoolers (KRISP), and the Multidimensional Stimulus Fluency Measure (MSFM) was used to assess ideational fluency and creative potential Contrary to expectations, no differences between reflective and impulsive preschoolers were found on the ideational fluency measure. However, analysis of all four quadrants of the conceptual tempo dimensions derived from median splits revealed an interaction of KRISP latency and error scores, F(157) = 12.78, p < .001, with greater originality scores evidenced by the fast/accurate and slow/inaccurate groups than the slow/ accurates and fast/inaccurates. Implications of this unusual finding were discussed in terms of the manner in which children may approach convergent and divergent tasks.     

Implementing a behavioral medicine program in an internal medicine residency: A description of curriculum content,resources and barriers encountered

Abstract

Many internal medicine training programs are currently developing curricula designed to teach the psychosocial aspects of patient care and doctor-patient communication skills. However, faculty may lack expertise regarding how to accomplish new educational goals in these areas. This article is designed to assist programs by describing in detail how a comprehensive behavioral medicine program was integrated into a general internal medicine program at a university-affiliated community hospital. It describes the program goals, resources needed, content included, obstacles to implementation and potential solutions to the problems encountered.     

Escape from the Island: Grammaticality and (Reduced) Acceptability of wh-island Violations in Danish

In the syntax literature, it is commonly assumed that a constraint on linguistic competence blocks extraction of wh-expressions (e.g. what or which book) from embedded questions, referred to as wh-islands. Furthermore, it is assumed that there is an argument/adjunct asymmetry in extraction from wh-islands. We report results from two acceptability judgment experiments on long and short wh-movement and wh-extraction from wh-islands in Danish. The results revealed four main findings: (1) No adjunct/argument asymmetry in extraction from wh-islands. (2) Long adjunct wh-movement is less acceptable than long argument wh-movement, and this difference is attributable to matrix verb compatibility and factivity, not D-linking. (3) Long movement reduces acceptability, but is more acceptable than island violations. (4) Training effects reveal that island violations, though degraded, are grammatical in Danish. Since the standard assumptions cannot account for the range of results, we argue in favor of a processing account referring to locality (processing domains) and working memory.     

Monte Carlo tests of the Rasch model based on scalability coefficients

For item responses fitting the Rasch model, the assumptions underlying the Mokken model of double monotonicity are met. This makes non‐parametric item response theory a natural starting‐point for Rasch item analysis. This paper studies scalability coefficients based on Loevinger's H coefficient that summarizes the number of Guttman errors in the data matrix. These coefficients are shown to yield efficient tests of the Rasch model using p‐values computed using Markov chain Monte Carlo methods. The power of the tests of unequal item discrimination, and their ability to distinguish between local dependence and unequal item discrimination, are discussed. The methods are illustrated and motivated using a simulation study and a real data example.     

Adolescent Motivations to Engage in Pro‐Social Behaviors and Abstain From Health‐Risk Behaviors: A Self‐Determination Theory Approach

The present study used self‐determination theory to examine adolescents' motivations to engage in charitable donating and community volunteering and to abstain from sexual intercourse and marijuana use. The sample consisted of 419 late adolescents recruited from across the country through an online survey panel. Participants completed online measures of motivations to engage in donating and volunteering, motivations to abstain from sex and marijuana, and single‐item indexes of the four behaviors. Variable‐centered analyses (correlation and regression) found evidence for a general motivational factor, motivational specificity by behavioral domain (positive and negative behaviors), motivational specificity by particular behavior (charitable donating, volunteering, sexual risk‐taking, and marijuana use), and a stronger relative role for autonomous motivations than controlled motivations. Person‐centered analyses (cluster analysis) found four motivation profiles (low motivation, medium motivation, high motivation, and mixed motivation) for all four behaviors and suggested that level of autonomous motivation was a key factor differentiating the groups on levels of behavior. The findings suggest different levels of motivational specificity and highlight the importance of autonomous motivations in predicting behaviors as compared to controlled motivations. Further, similar patterns were found for motivations to engage and to abstain.     

Social change in the aftermath of successful minority influence

This chapter describes a programme of research on group dynamics in the aftermath of successful minority influence that reverses minority and majority positions within a group. Supporting the authors' gain - loss asymmetry model of change, converging evidence suggests that loss of the majority position generates strong disidentification from the superordinate group whereas gaining the majority position does not yield comparable identification. This overall decrease in identification is associated with a general increase in hostility, reduced helpfulness, and a desire to exit the group. Thus groups may be especially fragile following internal changes in the majority - minority positions. Additional research suggests that such a pattern of reactions to majority - minority change is a specifically group phenomenon (versus aggregates of individuals) and occurs when majority - minority reversals follow the attitude change of existing group members (versus an influx of new members). New majorities will increase their identification with the group when converts provide genuine support or when their new majority position persists over time. Implications of these findings for intra-group relations in the aftermath of social change are discussed.