Treatment adherence of youth and young adults with and without a chronic illness

The positive impact of journaling on adolescents with cystic fibrosis

BACKGROUND

Individuals with cystic fibrosis (CF) often have psychological difficulties on top of their medically complex care, such as anxiety, depression, and medical mistrust. These have been shown to be associated with worse adherence, pulmonary function test results, and other health outcomes. In this pilot trial, we implemented a journaling program based on narrative therapy methodology to improve mental and physical health outcomes for individuals with CF.

METHODS

Eight adolescents aged 12-17 with a confirmed diagnosis of CF followed in a single center CF clinic were emailed weekly journaling prompts that explored topics like treatment adherence, feeling different with CF, anxiety, depression, and interpersonal relationships. Subjects completed surveys about their experience with the writing assignment and measures of wellness including the Pediatric Symptom Checklist (PSC-17) and baseline health data was collected from the electronic medical records.

RESULTS

The average score for the PSC-17 decreased by 5.5 points, and fell to less than 28 (mean 23.5, SD 12.2), which is the cutoff for screening positive for behavioral or emotional problems. Participants reported the study was enjoyable and had improvement in feelings of anxiety/depression. 100% of participants responded "Strongly Agree" to the statement "I recommend other people with CF to write about the topics from this study."

CONCLUSIONS

The journaling intervention for individuals with CF was feasible and well received. Initial results show improvement in PSC-17 and other well-being measures. Further studies are needed to evaluate the impact of journaling on mental health and disease outcomes.

Psychosocial functioning and adjustment to university settings: comparing students with chronic illnesses to healthy peers

Purpose: College students with chronic illnesses are vulnerable to poor adjustment, but it remains unclear how these students differ from healthy peers. This study compares psychosocial adjustment and risky behavior between students with and without chronic illnesses. Participants: Participants (N = 629, 78% Caucasian, 77% Female) were recruited from universities. Methods: Participants completed measures of illness history, anxiety, depression, stressful life events, social support, and risky behavior. Results: College students with chronic illnesses demonstrated significantly greater symptoms of anxiety F(1,620) = 8.742, p < .003, depression F(1,614) = 26.947, p < .001, more stressful life events F(1,476) = 23.671, p < .001, and lower social support F(1,613) = 15.645, p < .001. No differences in risky behaviors between groups emerged F(1,601) = 3.432, p = .064. An indirect effect of health status on risk-taking behavior was observed [b = .677, 95% CI (.351, 1.072)] partially mediated by depression. Conclusion: College students with chronic illnesses demonstrated worse psychosocial outcomes than healthy students, warranting programs to support these students. Depressive symptoms partially mediated risky behavior.

Clinical and psychosocial factors affecting treatment adherence in children with rheumatic heart disease

INTRODUCTION

The present study aimed to investigate the outcomes of psychiatric symptoms and family functions on treatment adherence in children, in addition to sociodemographic characteristics and clinical factors related to the disease.

MATERIAL AND METHOD

The research sample consisted of 43 children who were followed up with rheumatic heart disease diagnosis during the study. Clinical features were obtained from the patient files. The family assessment device evaluating family functioning and the strengths and difficulties questionnaire scale to screen emotional and behavioural problems in children were used.

RESULTS

Considering the regularity of treatment in our patients, there were 31 (72%) patients adherent to secondary prophylaxis regularly, 7 (6.9%) patients were partially adherent, and 5 (11.6%) patients non-adherent. Patients were divided into treatment adherent (Group 1) and non-adherent (Group 2). There was no statistically significant impact on treatment adherence whether the patients receive enough information, lifestyle, fear of developing adverse effects, fear of addiction, lack of health insurance, difficulties in reaching the drug or hospital. However, the fear of syringes on treatment adherence had an effect statistically significantly (p = 0.047). Forgetting to get a prescription and/or take the drug when the time comes was statistically higher in the non-adherent group (p = 0.009). There was no statistically significant effect of psychosocial factors on treatment adherence between groups.

DISCUSSION

Providing an effective active recall system, involving primary care workers, providing training on the disease and its management, and a comprehensive pain management programme can improve the process, especially for cases where secondary prophylaxis is missed.

Risk factors for nephropathy in persons with type 1 diabetes: a population-based study

AIMS

Albuminuria is strongly associated with risk of renal dysfunction, cardiovascular disease and mortality. However, clinical guidelines diverge, and evidence is sparse on what risk factor levels regarding blood pressure, blood lipids and BMI are needed to prevent albuminuria in adolescents and young adults with type 1 diabetes.

METHODS

A total of 9347 children and adults with type 1 diabetes [mean age 15.3 years and mean diabetes duration 1.4 years at start of follow-up] from The Swedish National Diabetes Registry were followed from first registration until end of 2017. Levels for risk factors for a risk increase in nephropathy were evaluated, and the gradient of risk per 1 SD (standard deviation) was estimated to compare the impact of each risk factor.

RESULTS

During the follow-up period, 8610 (92.1%) remained normoalbuminuric, 737 (7.9%) individuals developed micro- or macroalbuminuria at any time period of whom 132 (17.9% of 737) individuals developed macroalbuminuria. Blood pressure ≥ 140/80 mmHg was associated with increased risk of albuminuria (p ≤ 0.0001), as were triglycerides ≥ 1.0 mmol/L (p = 0.039), total cholesterol ≥ 5.0 mmol/L (p =  0.0003), HDL < 1.0 mmol/L (p = 0.013), LDL 3.5- < 4.0 mmol/L (p = 0.020), and BMI ≥ 30 kg/m² (p =  0.033). HbA1c was the strongest risk factor for any albuminuria estimated by the measure gradient of risk per 1 SD, followed by diastolic blood pressure, triglycerides, systolic blood pressure, cholesterol and LDL. In patients with HbA1c > 65 mmol/mol (> 8.1%), blood pressure > 140/70 mmHg was associated with increased risk of albuminuria.

CONCLUSIONS

Preventing renal complications in adolescents and young adults with type 1 diabetes need avoidance at relatively high levels of blood pressure, blood lipids and BMI, whereas very tight control is not associated with further risk reduction. For patients with long-term poor glycaemic control, stricter blood pressure control is advocated.

Childhood chronic condition and subsequent self-reported internalizing and externalizing problems in adolescence: a birth cohort study

Chronic conditions are common in childhood. We investigated the associations of childhood chronic conditions reported by parents with subsequent self-reported internalizing and externalizing problems in adolescence. A sample of 6290 children (3142 boys and 3148 girls) with data on chronic condition reported by parents both at 7 and at 16 years of age was obtained from the Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort (n = 9432) from an unselected, regionally defined population. Internalizing and externalizing problems were measured at 8 years of age with Rutter Children's Behavioral Questionnaire by teachers and at 16 years of age with Youth Self-Report by adolescents. When studying the effects of history of chronic conditions on these problems at 16 years of age, childhood internalizing and externalizing problems and social relations were adjusted. A history of chronic condition predicted subsequent somatic complaints among all adolescents. Early-onset chronic conditions were related to subsequent externalizing (OR 1.35; 1.02-1.79) and attention problems (OR 1.33; 1.01-1.75) and later onset of chronic conditions with internalizing (OR 1.49; 1.22-1.82) and thought problems (OR 1.50; 1.18-1.92). The effect was specific for sex and the type of chronic condition.

CONCLUSION

Childhood chronic conditions predicted internalizing and externalizing problems in adolescence. To prevent poor mental health trajectories, children with chronic conditions during their growth to adolescence need early support and long-term monitoring.

WHAT IS KNOWN

• Childhood adversities increase the risk of mental disorders. • Internalizing and externalizing problems have been suggested for measuring childhood and adolescent psychopathologies.

WHAT IS NEW

• Having a chronic condition (CC) before the age of 7 or later but before the age of 16 had different outcomes in adolescence. The early onset predicted externalizing problems, whereas the late onset predicted internalizing problems and thought problems in adolescence. The risk of somatic complaints was increased regardless of CC onset time. These findings can reflect more restricted ability to mental processing in the younger children.

Mobile and Web-Based Apps That Support Self-Management and Transition in Young People With Chronic Illness: Systematic Review

BACKGROUND

More adolescents with chronic physical illness are living into adulthood, and they require the development of proficient self-management skills to maintain optimal physical health as they transition into adult care services. It is often during this vulnerable transition period that deterioration in illness control is seen as a result of inadequate self-management skills and understanding of their chronic illness. Mobile technology has been proposed as an innovative opportunity to assist in improving the management of chronic conditions as young people transition to adult care services. Over the past 5 years, there has been a significant increase in research into the use of health-related apps.

OBJECTIVE

This study aimed to evaluate the utility and effectiveness of mobile and Web-based health apps that support self-management and transition in young people with chronic physical health illnesses.

METHODS

We conducted a comprehensive review of the literature in 5 bibliographic databases, using key search terms, considering only articles published from 2013, as we were extending the data from 2 previous systematic reviews. Abstracts were screened for possible inclusion by 2 reviewers. Data extraction and quality assessment tools were used for the evaluation of included studies.

RESULTS

A total of 1737 records were identified from the combined electronic searches, and 854 records were removed as duplicates. A total of 68 full articles were further assessed for eligibility, and 6 articles met our review criteria: 3 pilot studies, 2 randomized controlled trials, and 1 prospective cohort study. Publication years ranged from 2015 to 2018. The apps reported were targeted at type 1 diabetes mellitus, epilepsy, asthma, beta thalassemia major, and sickle cell disease, with a combined sample size of 336. A total of 4 studies included in this review reported being effective in increasing knowledge of the targeted condition and increasing therapy adherence, including increased medication adherence. A total of 2 manuscripts only mentioned the word transition. Participant's satisfaction was reported for all studies. Heterogeneity of the studies prevented meta-analysis.

CONCLUSIONS

There remain limited data on the effectiveness and use of mobile and Web-based apps, which might facilitate the transition of adolescents with chronic illnesses from pediatric to adult health care services. This systematic review provides an updated overview of available apps for adolescents with chronic illnesses. This systematic review has been unable to provide evidence for effectiveness of this approach, but it does provide insights into future study design, with reference to the development, evaluation, and efficacy of apps tailored for adolescents with chronic illnesses, including the involvement of adolescents in such designs.

TRIAL REGISTRATION

PROSPERO CRD42018104611; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=104611.

Exploring Medicines Burden Among Adults in New Zealand: A Cross-Sectional Survey

BACKGROUND

Using medicines regularly can be a burden for some people and can contribute to reduced adherence. In New Zealand, relatively few studies have examined people's medicine-taking experiences and most involved older people, although medicine burden is also an issue for younger people. The UK-developed "Living with Medicines Questionnaire" (LMQ-3) is an instrument designed to quantify medicine burden.

OBJECTIVE

The objective was to quantify medicines burden among New Zealand adults, using the LMQ-3, to identify any sub-populations with high medicine burden and to identify specific issues that may need to be addressed.

SETTING

The study was set in New Zealand and included seven national patient support group websites, and five community pharmacies in Dunedin.

METHODS

The survey was distributed to adults ≥18 years using ≥ one medicine for ≥3 months. LMQ-3 scores and domain scores were compared by patient characteristics using descriptive statistics and statistical tests.

RESULTS

In total, 472 responses were analysed: 327/417 (78.4%) from patient support group websites and 145/360 (40.3%) from community pharmacies. Most commonly participants were female (295, 62.5%), ≥65 years (236, 50.0%), European (422, 89.4%), retired (232, 49.2%), university educated (203, 43.0%), used medicines independently (449, 95.1%), and paid for prescriptions (429, 90.9%). Most used <10 medicines (415, 87.9%) and <three times daily (356, 75.4%). From LMQ scores, 30.5% had a high burden (≥111). Regression analysis indicated that higher LMQ-3 scores were associated with those who were unemployed, aged 18-29 years, using ≥5 medicines, or using medicines <3 times a day (p<0.01). Burden was mainly driven by a perceived lack of autonomy over medicine regimens, or concerns about medicines and side effects.

CONCLUSION

Three quarters of New Zealand participants experienced moderate or high medicine burden. Being unemployed, aged 18-29 years, or using more (or more frequent) medicines, were associated with higher burden. These groups should become the target for interventions seeking to reduce medicine burden.

Youth and young adults with acquired brain injury transition towards work-related roles: a qualitative study

PURPOSE

The purpose of this research was to explore the experiences of youth and young adults with acquired brain injury as they transition towards work-related roles. Little is known about employment experiences among this age group. Understanding their perspectives can inform programs and clinical practice.

MATERIALS AND METHODS

A descriptive qualitative design, including semi-structured interviews with 14 participants (8 females; 6 males) was used. Interviews were transcribed verbatim and analyzed using an open-coding, thematic approach.

RESULTS

Three major themes emerged related to the experience of work-related roles: (1) getting to know the new me; (2) navigating support systems; and (3) taking control of my experience. Some participants used coping strategies to acquire and/or maintain work-related roles, while others felt limited by their condition.

CONCLUSIONS

A variety of work-related roles, people, and environments directly and indirectly influenced the work-related transition of youth and young adults with acquired brain injury. Individuals expressed the importance of acquired brain injury awareness in informing others about their impairments. In fact, a lack of acquired brain injury awareness was often a main reason for receiving less than adequate support and accommodations. Without an understanding of acquired brain injury, people in the lives of these individuals were unable to perceive the legitimacy of acquired brain injury-related impairments. Implications for rehabilitation The purpose of this study is to understand the experiences of youth and young adults with acquired brain injury as they transition into work-related roles. Using these experiences as a guideline can promote acquired brain injury awareness, and contribute to how current interventions are designed and delivered. Clinicians should ensure that youth and young adults with acquired brain injury have access to the resources they need to maximize their independence. Healthcare professionals can play a pivotal role in relaying important acquired brain injury-related education, implementing suitable treatment plans, and providing them with effective tips to help them through their transition. A healthy transition to work-related roles should include ample social support and communication, acquired brain injury-related information that informs the community of acquired brain injury impairments, needs, and recovery trajectory, as well as adequate and consistent coordination within and between the person and the environment.

Missed opportunities for adolescent friendly care in hospital

AIM

To investigate whether adolescent friendly care, as defined by current best practice, was being provided within a hospital setting.

METHODS

All patients aged 12-18 presenting to Tauranga Hospital over a 5-week period were invited to complete a questionnaire on their experience of care. Responses were obtained from 319 adolescents (40% response rate).

RESULTS

Adolescents reported that staff were generally friendly (>80%) and respectful (>90%) and that they trusted staff to care for them (90%). Explanations were considered clear by 87% of adolescents, but 20% felt uncomfortable asking questions. Confidentiality was discussed with some adolescents (52%). Privacy was provided (93%), and most adolescents (86%) were satisfied with the extent of their involvement in consultations. Adolescents reported that staff did not routinely undertake psychosocial assessments. The physical environment and resources did not always meet the needs of adolescents, with 70% complaining about a lack of access to other adolescents.

CONCLUSION

While adolescents rated the care they received highly, the care did not always align with best practices regarding adolescent friendly care. There is ample opportunity for improvement.

The impact of motivational interviewing on adherence and symptom severity in adolescents and young adults with chronic illness: A systematic review

OBJECTIVE

Given the negative consequences associated with non-adherence in adolescents and young adults (AYAs) with chronic illness, it is important to identify interventions to address this issue. Therefore, this review's primary objective is to evaluate the impact of motivational interviewing (MI) on adherence and symptom level/severity in AYAs with chronic illness using a modified Cochrane method.

METHOD

Four databases (e.g., CINAHL, Medline, PsychINFO, and International Pharmaceutical Abstracts) were systematically reviewed. 121 articles were identified in the initial search. Article eligibility was assessed on two tiers using the inclusion criteria.

RESULTS

Twelve articles were retained for data extraction. Diabetes, asthma, and HIV were the most common chronic illness populations examined in the study. Eleven of the twelve articles provided support for either improved adherence, symptom reduction, or a combination of both after participants received MI. Quality of life was also enhanced in three studies.

CONCLUSION

Because adherence and symptom levels were positively impacted, it appears that MI may be a promising intervention for AYAs with chronic illness in addressing non-adherence and potentially improving quality of life.

PRACTICE IMPLICATIONS

Healthcare providers should consider implementing MI in their practice to establish rapport and potentially improve long-term health outcomes for AYAs with chronic illness.

Systematic Review of Screening Instruments for Psychosocial Problems in Children and Adolescents With Long-Term Physical Conditions

Children and adolescents with long-term physical conditions (LTPCs) are at greater risk of developing psychosocial problems. Screening for such problems may be undertaken using validated psychometric instruments to facilitate early intervention. A systematic review was undertaken to identify clinically utilized and psychometrically validated instruments for identifying depression, anxiety, behavior problems, substance use problems, family problems, and multiple problems in children and adolescents with LTPCs. Comprehensive searches of articles published in English between 1994 and 2014 were completed via Medline, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases, and by examining reference lists of identified articles and previous related reviews. Forty-four potential screening instruments were identified, described, and evaluated against predetermined clinical and psychometric criteria. Despite limitations in the evidence regarding their clinical and psychometric validity in this population, a handful of instruments, available at varying cost, in multiple languages and formats, were identified to support targeted, but not universal, screening for psychosocial problems in children and adolescents with LTPCs.

Next steps for adolescent and young adult oncology workshop: An update on progress and recommendations for the future

Each year, 70,000 adolescents and young adults (AYAs) between ages 15 and 39 years in the United States are diagnosed with cancer. In 2006, a National Cancer Institute (NCI) Progress Review Group (PRG) examined the state of science associated with cancer among AYAs. To assess the impact of the PRG and examine the current state of AYA oncology research, the NCI, with support from the LIVESTRONG Foundation, sponsored a workshop entitled "Next Steps in Adolescent and Young Adult Oncology" on September 16 and 17, 2013, in Bethesda, Maryland. This report summarizes the findings from the workshop, opportunities to leverage existing data, and suggestions for future research priorities. Multidisciplinary teams that include basic scientists, epidemiologists, trialists, biostatisticians, clinicians, behavioral scientists, and health services researchers will be essential for future advances for AYAs with cancer.

Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review

PURPOSE

To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions.

METHODS

A systematic search of Web of Science, PubMed, Embase, PsycINFO, and CINAHL from January 2000 to May 2012 was conducted. Articles were included if they examined barriers to medication intake among chronically ill adolescents aged 13-19 years. Articles were excluded if adolescent's views on barriers to adherence were not separated from younger children's or caregiver's views. Data was analyzed using a thematic synthesis approach.

RESULTS

Of 3,655 records 28 articles with both quantitative, qualitative, and q-methodology study designs were included in the review. The synthesis led to the following key themes: Relations, adolescent development, health and illness, forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases.

CONCLUSION

Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment of barriers to medication adherence is important for both policy-makers and clinicians in planning interventions and communicating with adolescents about their treatment.

Using Orem's self-care model for asthmatic adolescents

PURPOSE

The aim of the study was to determine the effect of Orem's self-care model on the self-care of adolescents with asthma.

DESIGN AND METHODS

In this experimental design, adolescents with asthma (N = 80) received home visits and individualized care based on theory-guided nursing diagnoses. Patients in the experimental group were visited in their homes eight times, and those in the control group were visited two times.

RESULTS

The five self-care skills of medicine usage, peak expiratory flow meter usage, applying an asthma action plan, keeping a daily follow-up schedule, and protecting against triggering factors differed significantly between the first and last visits in the experimental group, whereas the self-care skills of adolescents in the control group did not change.

PRACTICE IMPLICATIONS

Applying Orem's self-care model increased the self-care skills of adolescents with asthma.

'It is life threatening but I don't mind'. A qualitative study using photo elicitation interviews to explore adolescents' experiences of renal replacement therapies

BACKGROUND

Renal replacement therapy (RRT) transforms the life prospects of young people with established renal failure. However, these treatments can have significant physiological and psychological implications for adolescents as they prepare to transition into adulthood. Health policies increasingly emphasize children and youth's active participation and consultation as users of health services, yet studies infrequently seek their experiences directly.

METHODS

  Adolescents receiving RRT in a large UK teaching hospital took photographs illustrating the impact of their condition and treatment on their lives. Qualitative photo elicitation interviews were conducted to explore the significance of the images and the young person's experiences. Interviews were analysed using descriptive thematic analysis.

RESULTS

Ten young people aged 13-17 years participated. Themes identified were: (1) understanding and acceptance of treatment; (2) living in a non-functioning body; (3) impact upon daily life; (4) sources of support. Young people found treatments challenging and experienced significant impact on relationships and daily routines. Yet, health was prioritized over body image and participants demonstrated great emotional resilience. Young people valued support from family and friends, although were wary of disclosing their condition in case it resulted in being highlighted as different. Young people reported hospital staff as being caring and professional, but their biggest virtue appeared to be their willingness to treat the young people as 'normal'.

CONCLUSIONS

  Young people engaged readily with the research, and frankly described the impact of RRT on their everyday lives. Service providers must ensure that adolescents' developmental needs are met as traditional tasks of adolescence may lose priority. However, it is also clear that young people's ability to cope with treatments should not be underestimated.

Adherence to oral chemotherapy in childhood acute lymphoblastic leukemia: an evolutionary concept analysis

PURPOSE/OBJECTIVES

To clarify the concept of adherence to daily oral chemotherapy in children with acute lymphoblastic leukemia (ALL), to examine its implications for clinical practice, and to provide a foundation for further research and knowledge development.

DATA SOURCES

Published literature identified through the MEDLINE®, CINAHL®, PsycINFO, and ERIC databases.

DATA SYNTHESIS

Identified attributes of adherence to oral chemotherapy in childhood ALL included motivation, persistence, collaboration, mindfulness, cognitive capacity, flexibility, active participation, and identification of key participants in the process. Identified antecedents included a diagnosis of leukemia, the perceived value of adherence, and patient, family, and healthcare system-related factors. Identified consequences included the potential for maintaining optimal drug levels and improving disease outcome, as well as increased patient and caregiver esteem through active participation in the process. Adherence in the context of childhood ALL is defined as the active self-care behavior of taking (or having the responsibility for administering) daily oral chemotherapy, in collaboration with and according to the instructions of the healthcare provider over a defined, prolonged treatment period.

CONCLUSIONS

Adherence to oral chemotherapy in childhood ALL is a complex, multidimensional behavior that involves not only a willingness to follow the prescribed regimen over a prolonged period, but also the cognitive capacity and psychomotor skills to carry out the process.

IMPLICATIONS FOR NURSING

Nurses should recognize the importance of clear communication of medication instructions, reinforcement of adherence-related behaviors, and assistance with common issues such as pill-swallowing skills and reminder systems in caring for children with ALL.

Living with haemodialysis: the experience of adolescents in Turkey

This study explored how adolescents receiving haemodialysis for end-stage renal disease were affected by their diagnosis and treatment. A qualitative approach was used, with data collected through individual interviews with 18 adolescents aged 12-20. Data were analysed using content analysis method. Adolescents reported physical, psychological and social problems. Compliance related to diet and fluid restrictions were issues for the adolescents interviewed. Body image problems related to physical limitations and the fistula were described. Their regular school attendance was reduced by the illness and therapy, as were socialization and peer interactions. Adolescents felt different from their friends/peers and had negative feelings about their future. Nurses need to assess each adolescent to determine their responses and take action to assist the adolescents with the many issues they are likely to experience. Parents and siblings, who contribute significantly to the care of adolescents on haemodialysis, also require support.

Predictors of medication adherence in children receiving psychotropic medication

AIM

Medication adherence is poor in many young people with chronic illness. However, little research has examined medication adherence in clinic samples of young people receiving psychotropic medication, and whether factors such as disorder or drug type influence adherence. This study aimed to examine medication adherence in children and adolescents receiving psychotropic medication.

METHODS

Young people receiving psychotropic medication and their caregivers were recruited from pharmacy and mental health services within a large metropolitan hospital. A brief cross-sectional survey examined medication history, missed doses within the previous week and other clinical information. Multiple regression analysis examined whether child characteristics, drug type and regimen characteristics were associated with medication adherence.

RESULTS

Poor adherence was associated with lack of parental involvement in medication routines (P < 0.05), use of complementary medicines (P < 0.01) and difficulty remembering doses (P < 0.01). Developmental diagnoses (P < 0.05), use of antipsychotics (P < 0.05) and use of concomitant non-psychotropic medication (P < 0.05) were predictors of good adherence.

CONCLUSION

Encouraging parental involvement in medication routines may be a practical target for clinicians aiming to improve medication adherence in young people. Use of complementary medicines may indicate a group with a higher risk of poorer adherence.

Clinical research in adolescents: challenges and opportunities using obesity as a model

Adolescent medicine is relatively young, compared to paediatric or adult medicine. Descriptive and observational studies have dominated the adolescent literature, including those studies published in the International Journal of Obesity. In addition, many studies have combined child and adolescent age groups, making it difficult to determine adolescent-specific outcomes. It is important that high quality intervention studies in adolescents occur. Adolescence is a time of extraordinary plasticity. Habits, attitudes and physical morbidity that develop during adolescence set up trajectories that have a profound influence on health and wellbeing for the long term. Overweight and obesity are an excellent example of the need for high quality intervention studies and yet in the last two decades there have been very few randomized, controlled trials of overweight and obesity management in adolescents. There are a number of complexities in adolescent research that create additional challenges to those that accompany any clinical research. These include recruitment and retention, issues around consent and confidentiality and the central role that parents play in supporting the research protocol. Pubertal stage is a potential confounder and needs to be accurately measured. This is certainly true for studies in overweight and obesity where excess adiposity influences pubertal and other hormones. The opportunities to undertake quality research in adolescents are likely to be enhanced by the use of novel approaches which acknowledge the unique features of adolescents and their world.

Current issues in pediatric medication adherence

With the recent emphasis on investigating the efficacy of medication in children, it is also important to assess what determines whether pediatric patients do or do not take their medication. In general, children are no better at adhering to drug therapy than older individuals. Dealing with medication nonadherence is essential given its association with a failure to achieve the desired treatment goal. In addition to the many factors that influence adherence in adults, there are some unique challenges faced in the pediatric age group including the role of family (and its dysfunction), the changes of adolescence, and the lack of appropriate drug formulations. Intervention strategies to improve adherence include behavioral and educational strategies. Although there is no consensus as to what is the best approach to promote adherence with therapy, attention should be given to determining what barriers exist and trying to overcome them by involving children and their parents in the treatment planning process. If possible, the medication regimen, taking into account the frequency and timing of administration, should be tailored to the child and family's lifestyle and daily routine. Consideration should be given to the palatability and formulations of medications prescribed for young children. The use of simplified regimens of better tasting medications and age-appropriate delivery mechanisms may enhance the ability of pediatric patients to adhere to their drug therapy.

Psychological factors affecting disease activity in children and adolescents with cystic fibrosis: medical adherence as a mediator

PURPOSE OF REVIEW

It is likely that nonadherence to treatment is one mediator of the effect of psychological factors on disease activity and course of cystic fibrosis. Nonadherence is a significant problem for patients with the disease. This review assesses adherence to multiple treatment components in cystic fibrosis and identifies factors associated with poor adherence. Based on this assessment, strategies aimed at enhancing adherence will be discussed.

RECENT FINDINGS

Adherence to treatment occurs less than 50% of the time in patients with cystic fibrosis, indicating poor adherence, which is particularly common in adolescents. Factors associated with poor adherence include psychiatric, psychological and emotional factors; family issues; and treatment-related problems. Recently, more information is being gathered regarding processes related to poor adherence.

SUMMARY

Psychological factors affecting physical conditions frequently occur in children with cystic fibrosis. Therefore, patients need to be routinely screened for coexisting psychosocial issues and treatment adherence problems. Adherence needs to be examined according to the specific treatment component, and with an understanding of factors that make adherence difficult for patients and families. This will enable healthcare teams to target individualized strategies to counteract nonadherence, with emphasis on the role of psychological and psychosocial factors.

Adesão ao tratamento psicofarmacológico

Nesta revisão de literatura procuramos identificar os principais conteúdos relacionados à adesão do doente mental ao tratamento psicofarmacológico: definições, implicações, resultados. Realizamos a revisão bibliográfica nas bases Medline e Pubmed com as palavras chave adesão, medicação antipsicótica e doença mental. Foram selecionados 52 trabalhos. A maioria deles (73 %) buscou identificar fatores que podem influenciar adesão aos tratamentos. Os 27% restantes buscaram avaliar a influência de intervenções profissionais na adesão. Os principais fatores relatados relacionaram-se ao paciente, tipo de medicamento, fatores sociais. Com respeito às intervenções, aquelas que combinaram estratégias educacionais e comportamentais foram mais eficientes.

Self-management of medication for mental health problems by homeless young people

Youth homelessness is a growing Australian and international concern associated with considerable health disadvantage, including serious mental health problems. This paper reports findings of a qualitative study that explored young homeless people's experiences of mental health and well-being through in-depth interviews. Thematic analysis identified medication use and management as a central issue for the young people. Reasons identified for medication non-adherence included unwanted side-effects, issues of access and storage, and lack of support from health and social agencies. These problems were compounded by everyday stresses of homelessness. Medication adherence was facilitated by social support, consistent contact with supportive health services, and regular medication supply, often resulting in improved mental health and well-being. For these young people, prioritizing management of medication helped stabilize one aspect of their lives. Health professionals can play an important role in helping them achieving this goal.

Problem of nonadherence in chronically ill adolescents: strategies for assessment and intervention

PURPOSE OF REVIEW

Nonadherence to medical treatment is a significant problem for adolescents with chronic illness, with significant morbidity and mortality. Yet efforts to assess and treat the problem have been limited. We reviewed the literature on the factors associated with nonadherence and focused on nonadherence in a series of interviews with staff at a pediatric transplant program. This paper describes some of our findings, offers guidelines for assessing nonadherence in a primary care setting, and discusses strategies and interventions aimed at enhancing adherence. We refer to clinical cases derived from our interviews with renal transplant staff and our own clinical practice.

RECENT FINDINGS

Nonadherence to treatment recommendations occurs in approximately one-third of adolescents with a chronic illness. Factors that have been associated with nonadherence include psychiatric illness, psychological factors, family issues, and health problems. Although extensive research has been done on the problem of poor patient adherence in pediatric chronic illnesses, the prevalence of nonadherence remains high, and the research itself is problematic because of different definitions and methods of assessment used. Novel treatment strategies to improve adherence have been proposed, and data on these are emerging.

SUMMARY

Nonadherence in adolescents with chronic illness is a serious problem in need of greater recognition and intervention and further research. The primary care physician may be able to reduce nonadherence by routinely evaluating for adherence issues and initiating a targeted strategy to combat nonadherence when it is found. This review describes strategies and specific approaches for identifying and treating nonadherence in adolescents and their families.