Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication.

Aspects of patient and clinician language predict adherence to antidepressant medication.

J Am Board Fam Med. 2013 Jul-Aug; 26(4): 409-20
Kaplan JE, Keeley RD, Engel M, Emsermann C, Brody D

Objective: High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians’ language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and “motivational interviewing spirit”) along with patients’ “change talk” (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of >180 days covered (PDC) (primary outcome), were measured based on pharmacy records.Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: rs ?0.27; P < .05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: rs ?0.25; P < .05). In an adjusted analysis, empathy (t = 2.3; P = .027) and ?2 CT statements (t = 2.3; P = .024) were associated with higher PDC.Clinician empathy, reflections, and MIAs may elicit patient CT, whereas empathy and CT seem to enhance filling an initial prescription and PDC. HubMed – depression

Psychosocial and educational outcomes of weight faltering in infancy in ALSPAC.

BMJ Open. 2013; 3(7):
Holme AR, Blair PS, Emond AM

To investigate whether infants with weight faltering have impaired psychosocial and educational outcomes in later childhood.Follow-up of infants with weight faltering in a large UK cohort study.The Avon Longitudinal Study of Parents and Children (ALSPAC).11 534 term infants from ALSPAC with complete weight records. Weight gain (conditional on initial weight) was calculated for three periods: from birth to 8 weeks, 8 weeks to 9 months, and birth to 9 months. Cases of weight faltering were defined as those infants with a conditional weight gain below the 5th centile, and these were compared with the rest of the cohort as the control group.Between 6 and 11 years, social, emotional and behavioural development was measured by direct assessment of the children and parental and teacher report. Educational outcomes included Standardised Assessment Test results at 7 and 11 years and Special Educational Needs status at age 11.Differences seen on univariate analysis in attention, non-verbal accuracy, educational attainment and special educational needs became non-significant after adjustment for confounding. Children with weight faltering in infancy did not differ from controls on any measures of self-esteem, peer relationships, experience of bullying, social cognition, antisocial activities, anxiety, depression or behavioural problems.Weight faltering in early infancy was associated with poorer educational outcomes in later childhood, but these associations were explained by confounding. The subsequent psychosocial development of infants with slow weight gain was not different from that of their peers. HubMed – depression

[Age-related White Matter Lesions (Leukoaraiosis): An Update].

Brain Nerve. 2013 Jul; 65(7): 789-99
Miki Y, Sakamoto S

Abstract Leukoaraiosis (age-related white matter hyperintensities) is the most frequently seen lesion on brain magnetic resonance (MR) images. This lesion is a subject of much current interest, because a number of multicenter studies have revealed that it is associated with various disturbances and poor prognoses. Leukoaraiosis corresponds to various pathologies, including demyelination, apoptosis, edema, dilated perivascular spaces, axonal damage, gliosis, and infarcts. Also noted in leukoaraiosis are changes in small vessels, such as fibrohyalinosis and venous collagenosis. The main cause of leukoaraiosis is thought to be chronic ischemia; other causes include edema and breakdown of the blood-brain barrier. Major risk factors for leukoaraiosis are age and hypertension. Disturbances that are related to leukoaraiosis include stroke, dementia, cognitive impairment, gait disturbance, fall, and depression. Leukoaraiosis is also a risk factor for death. Technologies, such as automatic volumetry, tissue segmentation, diffusion tensor imaging, magnetization tensor imaging, diffusion kurtosis imaging, and ultra-high field MR imaging may provide further insights into leukoaraiosis. HubMed – depression