Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disabili... more Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disability, and reduced life expectancy. Highly effective drugs are now available for the treatment of RA. However, poor adherence to drug regimens remains a significant barrier to improving clinical outcomes in RA. Poor adherence has been shown to be linked to patients' beliefs about medicines with a potential impact on adherence. These beliefs are reported to be different between ethnic groups. The purpose of this study was to identify potential determinants of adherence to disease modifying anti-rheumatic drugs (DMARDs) including an assessment of the influence of beliefs about medicines and satisfaction with information provided about DMARDs and compare determinants of adherence between RA patients of White British and South Asian. RA patients of either White British (n = 91) or South Asian (n = 89) origin were recruited from secondary care. Data were collected via questionnaires on patients': (1) self-reported adherence (Medication Adherence Report Scale-MARS); (2) beliefs about medicines (Beliefs about Medicines Questionnaire-BMQ); (3) illness perceptions (Illness Perceptions Questionnaire-IPQ) and (4) satisfaction with information about DMARDs (Satisfaction with Information about Medicines questionnaire-SIMS). In addition, clinical and demographic data were collected. The results revealed that socio-demographic factors only explained a small amount of variance in adherence whereas illness representations and treatment beliefs were more substantial in explaining non-adherence to DMARDs. Patients' self-reported adherence was higher in White British than South Asian patients (median 28 (interquartile range 26-30) vs median 26 (interquartile range 23-30) respectively; P = 0.013, Mann-Whitney test). Patients who reported lower adherence were more dissatisfied with the information they had received about their DMARDs (P < 0.001, Spearman correlation, SIMS action and usage subscale; P < 0.001, Spearman correlation, SIMS potential problems subscale) and had more negative beliefs about their DMARDs and were related to ethnicity with South Asian patients having more negative views about medicines. Socio-demographic factors were found to explain a small amount of variance in adherence. Illness representations and treatment beliefs were more important in explaining non-adherence to DMARDs. Clinicians managing South Asian patients with RA need to be aware that low adherence may be linked to negative beliefs about medicines and illness representations of RA.
Petrological data collected from the 1991-1992 and 2005-2006 eruptions provide a record of the co... more Petrological data collected from the 1991-1992 and 2005-2006 eruptions provide a record of the compositional evolution of erupted magmas over a 14-15 year period at the East Pacific Rise near 9°50' N. This data, when coupled with mathematical modeling of convection and replenishment, present a unique opportunity to understand coupled magmatic and hydrothermal processes at a fast-spreading oceanic ridge. We use the multicomponent geochemical modeling software MELTS (Ghiorso and Sack, 1995; Asimow and Ghiorso, 1998) to determine how the sub-axial magma lens has evolved as a result of cooling, crystal fractionation, and melt replenishment in the period between the 1991 and 2005 eruptions. Following a spreading rate-dependent permeability barrier model for lateral melt transport and extraction (Hebert and Montesi, submitted), and utilizing an initial depleted mantle source (DMM, Workman and Hart, 2005) under anhydrous conditions and with a potential temperature of 1375°C, we obtain a starting composition for the sub-axial magma lens. A liquid line of descent involving simple fractionation for this composition passes through the 1991-1992 lava dataset. We then implemented isobaric fractionation calculations, using MELTS. We tested an array of scenarios including simple fractionation, replenishment with both more and less evolved magmas, the addition of water, and changes in oxygen fugacity. Our initial temperature conditions were set by the results of a 2-D geodynamic ridge model, and replenishment timescales and cooling rates were guided by the modeling study of Liu and Lowell (2009). Simple fractionation can explain the evolution of the magmas for some of the major elements, but not all of them. Therefore, we argue that some amount of replenishment must have occurred in the magma chamber between eruptions to explain the small change in composition as well as temperature. The results are independent of whether the replenishment is continuous or periodic. The observed changes cannot be explained by anhydrous replenishment using more evolved magmas. The conditions that best match the evolution of the 1991-1992 lavas to the 2005-2006 lavas are hydrous replenishment of a more primitive composition with oxygen fugacity at the QFM buffer. The petrological results are consistent with a mathematical model of a rapidly mixed convecting, cooling, replenished magma chamber, in which crystals are assumed to settle rapidly to the floor.
Http Dx Doi Org 10 1080 08870440008400297, Dec 19, 2007
Abstract We identify potential problems in the statistical analysis of social cognition model dat... more Abstract We identify potential problems in the statistical analysis of social cognition model data, with special emphasis on the theories of reasoned action (TRA) and planned behaviour (TPB). Some statistical guidelines are presented for empirical studies of the TRA and the TPB based upon multiple linear regression and structural equation modelling (SEM). If the model is tested using multiple regression, the assumptions of this technique must be considered and variables transformed if necessary. Adjusted R2 (not R2) should ...
Nonadherence to phosphate binding medication (PBM) compromises the efficacy of treatment for chro... more Nonadherence to phosphate binding medication (PBM) compromises the efficacy of treatment for chronic kidney disease, but its causes are poorly understood. This study sought to explore patient attitudes towards PBM and to evaluate the utility of the necessity-concerns framework for understanding adherence to PBM. A sample of 221 dialysis patients currently prescribed PBM were surveyed from eight UK renal units. Demographic data and clinical information, alongside the Beliefs about Medicines Questionnaire and the medication adherence report scale were reported. Low adherence to PBM was predicted by reduced beliefs in personal need for PBM (OR = .34; 95% CI: .14-.83; p < .05), and increased concerns about PBM (OR = 3.17; 95% CI: 1.87-5.37; p < .001). Patients were categorised into attitudinal groups based on their beliefs about PBM and being 'skeptical' of PBM (low necessity beliefs and high concerns) was most associated with low adherence. Strategies to improve adherence to PBM should aim to elicit and address patients' beliefs about their personal need for PBM and their concerns about this medication.
The belief that one is especially sensitive to the actions and side effects of medicines can infl... more The belief that one is especially sensitive to the actions and side effects of medicines can influence treatment adherence and side-effect reporting. In this study, we investigated the prevalence of perceived medication sensitivity in the general population and its relationship to symptom complaints, information seeking about medications, use of medical care and demographic factors. A nationally representative sample of 1000 New Zealand residents completed the Perceived Sensitivity to Medicines scale and symptoms experienced during the previous 7 days. Demographic data and medical visits, medication use and information seeking about medicines were also collected. Over 20% of the general population reported being very sensitive to the effects of medication (20.2%) and that small amounts of medicines can upset their body (25.3%). Participants who reported high levels of perceived sensitivity to medicines reported significantly more symptoms (M = 9.54, SE = 0.47) than people with low (...
There has been a continuing debate about the extent to which the public finds health-care technol... more There has been a continuing debate about the extent to which the public finds health-care technological innovation acceptable. The public's ambivalence about scientific medicine may have been exacerbated, more recently, by developments such as the introduction of the 'new genetics' with their associated ethical and social implications and the claims that public trust in health care and practitioners and, more widely, in society has been eroded. The aim of this paper is to examine public attitudes to a range of innovative health-care technologies to see whether (i) certain technologies are perceived as particularly problematic, and (ii) attitudes to new health-care technologies are associated more broadly with beliefs about science, trust in health care and social trust, and perceptions of the benefits and risks of complementary and alternative medicine versus orthodox (technological) medicine. These questions are examined through a statistical analysis of data collected ...
Page 1. doi:10.1136/heart.86.1.91 2001;86;91-93 Heart MOSS-MORRIS KATE PERRY, KEITH J PETRIE, CHR... more Page 1. doi:10.1136/heart.86.1.91 2001;86;91-93 Heart MOSS-MORRIS KATE PERRY, KEITH J PETRIE, CHRIS J ELLIS, ROBERT HORNE and RONA myocardial infarction patients Symptom expectations and delay in acute ...
... 1,§ ,; James I. Hudson MD 1 ,; James M. Ferguson MD 2 ,; Robert L. Horne ... Pope, HG, McElro... more ... 1,§ ,; James I. Hudson MD 1 ,; James M. Ferguson MD 2 ,; Robert L. Horne ... Pope, HG, McElroy, SL, Keck, PE, Hudson, JI, Ferguson, JM and Horne, RL (1989 ... Assistant Professor of Psychiatry, Epidemiology Laboratory, Laboratories for Psychiatric Research, McLean Hospital, and ...
Nonadherence to immunosuppressants in renal transplant recipients is a major factor affecting gra... more Nonadherence to immunosuppressants in renal transplant recipients is a major factor affecting graft survival, but it is difficult to detect accurately in clinical practice. Adherence was measured in 153 adult renal transplant recipients using self-report questionnaires and interview, clinician rating, and cyclosporine levels. The sensitivity and specificity of these measures were determined by comparison with electronic monitoring in a randomly selected subsample of 58 subjects. Measures of adherence in current clinical use do not perform well when tested against electronic monitoring. Self-report at a confidential interview was the best measure of adherence for the detection of both missed doses and erratic timing of medication. However, the use of a confidential interview is not directly applicable to a clinical setting. Further research on how best to facilitate disclosure in clinical settings may be the best way to develop adherence measures for use in routine practice.
Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring... more Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring a correct diagnosis of asthma is the first step in assessing poor symptom control; this requires returning to the basics of history taking and physical examination, in conjunction with lung function measurement when appropriate. A number of factors may contribute to sub-optimal asthma control. Concomitant rhinitis, a common co-pathology and contributor to poor control, can often be identified by asking a simple question. Smoking too has been identified as a cause of poor asthma control. Practical barriers such as poor inhaler technique must be addressed. An appreciation of patients' views and concerns about maintenance asthma therapy can help guide discussion to address perceptual barriers to taking maintenance therapy (doubts about personal necessity and concerns about potential adverse effects). Further study into, and a greater consideration of, factors and patient characteristic...
Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disabili... more Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disability, and reduced life expectancy. Highly effective drugs are now available for the treatment of RA. However, poor adherence to drug regimens remains a significant barrier to improving clinical outcomes in RA. Poor adherence has been shown to be linked to patients' beliefs about medicines with a potential impact on adherence. These beliefs are reported to be different between ethnic groups. The purpose of this study was to identify potential determinants of adherence to disease modifying anti-rheumatic drugs (DMARDs) including an assessment of the influence of beliefs about medicines and satisfaction with information provided about DMARDs and compare determinants of adherence between RA patients of White British and South Asian. RA patients of either White British (n = 91) or South Asian (n = 89) origin were recruited from secondary care. Data were collected via questionnaires on patients': (1) self-reported adherence (Medication Adherence Report Scale-MARS); (2) beliefs about medicines (Beliefs about Medicines Questionnaire-BMQ); (3) illness perceptions (Illness Perceptions Questionnaire-IPQ) and (4) satisfaction with information about DMARDs (Satisfaction with Information about Medicines questionnaire-SIMS). In addition, clinical and demographic data were collected. The results revealed that socio-demographic factors only explained a small amount of variance in adherence whereas illness representations and treatment beliefs were more substantial in explaining non-adherence to DMARDs. Patients' self-reported adherence was higher in White British than South Asian patients (median 28 (interquartile range 26-30) vs median 26 (interquartile range 23-30) respectively; P = 0.013, Mann-Whitney test). Patients who reported lower adherence were more dissatisfied with the information they had received about their DMARDs (P < 0.001, Spearman correlation, SIMS action and usage subscale; P < 0.001, Spearman correlation, SIMS potential problems subscale) and had more negative beliefs about their DMARDs and were related to ethnicity with South Asian patients having more negative views about medicines. Socio-demographic factors were found to explain a small amount of variance in adherence. Illness representations and treatment beliefs were more important in explaining non-adherence to DMARDs. Clinicians managing South Asian patients with RA need to be aware that low adherence may be linked to negative beliefs about medicines and illness representations of RA.
Petrological data collected from the 1991-1992 and 2005-2006 eruptions provide a record of the co... more Petrological data collected from the 1991-1992 and 2005-2006 eruptions provide a record of the compositional evolution of erupted magmas over a 14-15 year period at the East Pacific Rise near 9°50' N. This data, when coupled with mathematical modeling of convection and replenishment, present a unique opportunity to understand coupled magmatic and hydrothermal processes at a fast-spreading oceanic ridge. We use the multicomponent geochemical modeling software MELTS (Ghiorso and Sack, 1995; Asimow and Ghiorso, 1998) to determine how the sub-axial magma lens has evolved as a result of cooling, crystal fractionation, and melt replenishment in the period between the 1991 and 2005 eruptions. Following a spreading rate-dependent permeability barrier model for lateral melt transport and extraction (Hebert and Montesi, submitted), and utilizing an initial depleted mantle source (DMM, Workman and Hart, 2005) under anhydrous conditions and with a potential temperature of 1375°C, we obtain a starting composition for the sub-axial magma lens. A liquid line of descent involving simple fractionation for this composition passes through the 1991-1992 lava dataset. We then implemented isobaric fractionation calculations, using MELTS. We tested an array of scenarios including simple fractionation, replenishment with both more and less evolved magmas, the addition of water, and changes in oxygen fugacity. Our initial temperature conditions were set by the results of a 2-D geodynamic ridge model, and replenishment timescales and cooling rates were guided by the modeling study of Liu and Lowell (2009). Simple fractionation can explain the evolution of the magmas for some of the major elements, but not all of them. Therefore, we argue that some amount of replenishment must have occurred in the magma chamber between eruptions to explain the small change in composition as well as temperature. The results are independent of whether the replenishment is continuous or periodic. The observed changes cannot be explained by anhydrous replenishment using more evolved magmas. The conditions that best match the evolution of the 1991-1992 lavas to the 2005-2006 lavas are hydrous replenishment of a more primitive composition with oxygen fugacity at the QFM buffer. The petrological results are consistent with a mathematical model of a rapidly mixed convecting, cooling, replenished magma chamber, in which crystals are assumed to settle rapidly to the floor.
Http Dx Doi Org 10 1080 08870440008400297, Dec 19, 2007
Abstract We identify potential problems in the statistical analysis of social cognition model dat... more Abstract We identify potential problems in the statistical analysis of social cognition model data, with special emphasis on the theories of reasoned action (TRA) and planned behaviour (TPB). Some statistical guidelines are presented for empirical studies of the TRA and the TPB based upon multiple linear regression and structural equation modelling (SEM). If the model is tested using multiple regression, the assumptions of this technique must be considered and variables transformed if necessary. Adjusted R2 (not R2) should ...
Nonadherence to phosphate binding medication (PBM) compromises the efficacy of treatment for chro... more Nonadherence to phosphate binding medication (PBM) compromises the efficacy of treatment for chronic kidney disease, but its causes are poorly understood. This study sought to explore patient attitudes towards PBM and to evaluate the utility of the necessity-concerns framework for understanding adherence to PBM. A sample of 221 dialysis patients currently prescribed PBM were surveyed from eight UK renal units. Demographic data and clinical information, alongside the Beliefs about Medicines Questionnaire and the medication adherence report scale were reported. Low adherence to PBM was predicted by reduced beliefs in personal need for PBM (OR = .34; 95% CI: .14-.83; p < .05), and increased concerns about PBM (OR = 3.17; 95% CI: 1.87-5.37; p < .001). Patients were categorised into attitudinal groups based on their beliefs about PBM and being 'skeptical' of PBM (low necessity beliefs and high concerns) was most associated with low adherence. Strategies to improve adherence to PBM should aim to elicit and address patients' beliefs about their personal need for PBM and their concerns about this medication.
The belief that one is especially sensitive to the actions and side effects of medicines can infl... more The belief that one is especially sensitive to the actions and side effects of medicines can influence treatment adherence and side-effect reporting. In this study, we investigated the prevalence of perceived medication sensitivity in the general population and its relationship to symptom complaints, information seeking about medications, use of medical care and demographic factors. A nationally representative sample of 1000 New Zealand residents completed the Perceived Sensitivity to Medicines scale and symptoms experienced during the previous 7 days. Demographic data and medical visits, medication use and information seeking about medicines were also collected. Over 20% of the general population reported being very sensitive to the effects of medication (20.2%) and that small amounts of medicines can upset their body (25.3%). Participants who reported high levels of perceived sensitivity to medicines reported significantly more symptoms (M = 9.54, SE = 0.47) than people with low (...
There has been a continuing debate about the extent to which the public finds health-care technol... more There has been a continuing debate about the extent to which the public finds health-care technological innovation acceptable. The public's ambivalence about scientific medicine may have been exacerbated, more recently, by developments such as the introduction of the 'new genetics' with their associated ethical and social implications and the claims that public trust in health care and practitioners and, more widely, in society has been eroded. The aim of this paper is to examine public attitudes to a range of innovative health-care technologies to see whether (i) certain technologies are perceived as particularly problematic, and (ii) attitudes to new health-care technologies are associated more broadly with beliefs about science, trust in health care and social trust, and perceptions of the benefits and risks of complementary and alternative medicine versus orthodox (technological) medicine. These questions are examined through a statistical analysis of data collected ...
Page 1. doi:10.1136/heart.86.1.91 2001;86;91-93 Heart MOSS-MORRIS KATE PERRY, KEITH J PETRIE, CHR... more Page 1. doi:10.1136/heart.86.1.91 2001;86;91-93 Heart MOSS-MORRIS KATE PERRY, KEITH J PETRIE, CHRIS J ELLIS, ROBERT HORNE and RONA myocardial infarction patients Symptom expectations and delay in acute ...
... 1,§ ,; James I. Hudson MD 1 ,; James M. Ferguson MD 2 ,; Robert L. Horne ... Pope, HG, McElro... more ... 1,§ ,; James I. Hudson MD 1 ,; James M. Ferguson MD 2 ,; Robert L. Horne ... Pope, HG, McElroy, SL, Keck, PE, Hudson, JI, Ferguson, JM and Horne, RL (1989 ... Assistant Professor of Psychiatry, Epidemiology Laboratory, Laboratories for Psychiatric Research, McLean Hospital, and ...
Nonadherence to immunosuppressants in renal transplant recipients is a major factor affecting gra... more Nonadherence to immunosuppressants in renal transplant recipients is a major factor affecting graft survival, but it is difficult to detect accurately in clinical practice. Adherence was measured in 153 adult renal transplant recipients using self-report questionnaires and interview, clinician rating, and cyclosporine levels. The sensitivity and specificity of these measures were determined by comparison with electronic monitoring in a randomly selected subsample of 58 subjects. Measures of adherence in current clinical use do not perform well when tested against electronic monitoring. Self-report at a confidential interview was the best measure of adherence for the detection of both missed doses and erratic timing of medication. However, the use of a confidential interview is not directly applicable to a clinical setting. Further research on how best to facilitate disclosure in clinical settings may be the best way to develop adherence measures for use in routine practice.
Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring... more Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring a correct diagnosis of asthma is the first step in assessing poor symptom control; this requires returning to the basics of history taking and physical examination, in conjunction with lung function measurement when appropriate. A number of factors may contribute to sub-optimal asthma control. Concomitant rhinitis, a common co-pathology and contributor to poor control, can often be identified by asking a simple question. Smoking too has been identified as a cause of poor asthma control. Practical barriers such as poor inhaler technique must be addressed. An appreciation of patients' views and concerns about maintenance asthma therapy can help guide discussion to address perceptual barriers to taking maintenance therapy (doubts about personal necessity and concerns about potential adverse effects). Further study into, and a greater consideration of, factors and patient characteristic...
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