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Chronic psychotic disorders (CPDs) occur worldwide and cause significant burden. Poor medication adherence is pervasive, but has not been well studied in sub-Saharan Africa.
This cross-sectional survey of 100 poorly adherent Tanzanian patients with CPD characterised clinical features associated with poor adherence.
Descriptive statistics characterised demographic and clinical variables, including barriers to adherence, adherence behaviours and attitudes, and psychiatric symptoms. Measures included the Tablets Routine Questionnaire, Drug Attitudes Inventory, the Brief Psychiatric Rating Scale, the Clinical Global Impressions scale, the Alcohol Use Disorders Identification Test and Alcohol, Smoking and Substance Involvement Screening Test. The relationship between adherence and other clinical variables was evaluated.
Mean age was 35.7 years (s.d. 8.8), 61% were male and 80% had schizophrenia, with a mean age at onset of 22.4 (s.d. 7.6) years. Mean proportion of missed CPD medication was 64%. One in ten had alcohol dependence. Most individuals had multiple adherence barriers. Most clinical variables were not significantly associated with the Tablets Routine Questionnaire; however, in-patients with CPD were more likely to have worse adherence (P ≤ 0.01), as were individuals with worse medication attitudes (Drug Attitudes Inventory, P < 0.01), higher CPD symptom severity levels (Brief Psychiatric Rating Scale, P < 0.001) and higher-risk use of alcohol (Alcohol Use Disorders Identification Test, P < 0.001).
Poorly adherent patients had multiple barriers to adherence, including poor attitudes toward medication and treatment, high illness acuity and substance use comorbidity. Treatments need to address adherence barriers, and consider family supports and challenges from an intergenerational perspective.
Low- and middle-income countries (LMICs) experience a disproportionate burden from chronic psychotic disorders (CPDs), which are the most disabling conditions among people aged 10–24 in Sub-Saharan Africa. Poor medication adherence is seen in approximately half of individuals with CPDs in Sub-Saharan Africa, and is a major driver of relapse. A CPD treatment approach that combines the use of long-acting injectable (LAI) antipsychotic medications with a brief and practical customised adherence-enhancement behavioural intervention (CAE-L) was recently developed and tested for use in the USA.
To use a qualitative cross-sectional analysis to gather information on potentially modifiable barriers to management of CPDs, and assess attitudes about LAIs from community participants in Tanzania. Findings were intended to refine the CAE-L curriculum for use in Tanzania.
In-depth interviews and focus groups were conducted with 44 participants (patients with CPD, caregivers, mental healthcare providers). All interviews and focus groups were audiotaped, translated, transcribed and analysed using content analysis, with an emphasis on dominant themes.
Findings indicated that promoting medication adherence and management of CPDs in the Tanzanian setting needs to consider the individual with CPD, the family, the healthcare setting and the broader community context.
Qualitative findings enabled the study team to better understand the real-time barriers to medication adherence, LAI use and management of CPDs more broadly. Refinement of the CAE-L is expected to pave the way for an intervention trial for individuals with CPDs that is culturally and linguistically appropriate to the Tanzanian setting.
This paper discusses the emergence of silver metallurgy some two millennia ago in the south central Andes. It is argued that the availability of multiple abundant resources and a high population density were instrumental in the development of this complex technology. The potential for such resource-rich environments to stimulate and sustain innovation is briefly discussed, particularly for prestige goods in societies engaged in socially competitive networks. The Puno Bay area of Lake Titicaca and its hinterland is shown to be one such resource-rich region, which may have contributed to its role in developing a complex and labour-intensive silver metallurgy as part of a larger mining-metallurgical landscape.
This paper reports on a multi-faceted evaluation of science communication workshops conducted during the summer of 2009 with Research Experience for Undergraduate (REU) students from the Center for High-rate Nanomanufacturing and the Harvard University School of Engineering and Applied Sciences, in a partnership between the Museum of Science, Boston Strategic Projects department and faculty from the Nanoscale Science and Engineering Centers headquartered at Harvard and at Northeastern Universities. The workshops were shown to (1) increase student interest in exploring and understanding the broader impacts of research, and (2) increase student knowledge, confidence and practice of communication skills for both professional and non-professional audiences.
HIV/AIDS has changed the world in profound and still-evolving ways. The last children born before HIV/AIDS emerged in the late 1970s and early 1980s are now in their mid-twenties, many with children of their own. All children born in the foreseeable future – at least for the next several decades – will be living in a world where the epidemic persists, albeit with variable consequences for each of them. Children, among the most vulnerable members of society, are bellwethers of adult leaders' willingness and capacity to respond to economic, health, and social challenges. What happens to children and adolescents now will determine not only their futures but also the futures of their families, communities, and societies.
In the first years of the HIV/AIDS epidemic, though, there was relatively little direct focus on children, particularly children who were not themselves HIV-infected but were nevertheless significantly affected by the disease. In the past decade or so the massive and growing number of orphans in Africa has received periodic media attention and many program responses. To be sure, in developed countries in North America and Europe, pediatric HIV/AIDS has become a highly sophisticated medical specialty. Treatments to reduce mother-to-child HIV transmission have succeeded extraordinarily well in these countries and are being introduced slowly in poor countries where the need is greatest. In every country affected by the epidemic, dedicated individuals and groups – most with very meager resources – serve children and families and advocate for more attention to their needs.