Self-regulation predictors of medication adherence among ethnically different pediatric patients with renal transplants.

OBJECTIVE: To predict medication adherence among ethnically different pediatric patients with renal transplants between the ages of 6 and 20 years old, using self-regulation variables including motivation, perceived control and responsibility, and perceived support. METHODS: Twenty-six African American children and 42 Caucasian children were verbally administered the Self-Regulation of Medication Adherence Battery to assess their (1) motivation to be medication adherent, (2) perceived control of and responsibility for medication adherence, and (3) perceived support of medication adherence from their primary caregiver. Four measures were used to assess medication adherence: self-ratings, nephrologists' ratings, cyclosporine levels, and pill count/refill histories. RESULTS: For the African American patients, regression analyses revealed that responses to motivation and perceived control questions that focused on self-efficacy were unique predictors of medication adherence as rated by their primary nephrologist. For the Caucasian patients, one motivation question regarding how often they forget to take their medication predicted their self-reported adherence. CONCLUSIONS: Facilitating their beliefs that they can regularly take their medications may help promote medication adherence among African American children with renal transplants, whereas for Caucasian children, providing cues and reminders to take their medications may help. We discuss implications of the results for multimodal assessment of medication adherence and for ethnic group-specific medication adherence research and interventions.

Motivators, resources and barriers in voluntary international migration of the elderly: The case of Israel-bound aged.

A conceptual model was developed and tested to identify personal and situational factors which differentiate successful from unsuccessful planners of voluntary long-distance moves among the elderly. Potential migrants to Israel were identified at their point of origin and followed-up to ascertain whether they actually moved. This group generally shared a desire for a more challenging lifestyle and for opportunities to help others. A comparison group of movers (N = 97) revealed that 'push' and 'pull' factors in the environment of destination were far more important in differentiating these two groups than were factors in the environment of origin. Attachments, personal ties and familiarity with the new environment also emerged as significant predictors of moving. Selective evaluations of advantages of the new environment and obstacles to the move also differentiated movers from non-movers. Being married and in good health served as useful resources to facilitate the move. ka]Key Words kb]cross-national migration kb]voluntary relocation kb]elderly migration kb]migrant characteristics kb]environments kb]migration.

Portal haemodynamics in subjects without signs of liver disease.

Haemodynamic parameters were investigated in 37 subjects without signs of liver disease. Pressures were simultaneously measured in hepatic veins accessible by catheterization. Mean values obtained for wedged and free hepatic vein pressures were 1.17 +/- 0.37 and 0.86 +/- 0.31 kPa. The relations of the parameters of hepatic circulation to central haemodynamic parameters were analysed. The magnitude of wedged and free hepatic vein pressures is directly proportionate to the magnitude of pressures in the inferior vena cava and in the right atrium and indirectly proportionate to the cardiac output (cardiac index). On the other hand, the magnitude of the hepatic venous pressure gradient is completely independent of all parameters of central circulation. The obtained data can serve as reference values for studying patients with liver disease and signs of portal hypertension as well as for evaluating the effect of their treatment.

Action of the triglycyl hormonogen of vasopressin (glypressin) in patients with liver cirrhosis and bleeding esophageal varices.

Seven patients with compensated liver cirrhosis and esophageal varices, all with a base line wedge hepatic vein pressure greater than 20 cm H2O, received 1-mg doses of vasopressin hormonogen (tGLVP) intravenously. There was a significant mean decrease in wedge pressure of 32%, which lasted for at least 20 min (the duration of measurement), with no change in cardiac output measured. The only cardiac response was a 10 to 20% bradycardia at the height of the moderate pressor response-otherwise the ECG was without change. In 5 patients who received the same tGLVP dose during surgery, direct measurements of portal venous pressure showed the same degree of decrease within 10 min of intravenous injection. Fifteen patients with liver cirrhosis and severe bleeding from esophageal varices were treated conservatively with blood transfusion and tGLVP as the only major drug aside from antibiotics. A nonrandomized control group of 13 patients with the same age distribution, stage of disease, number of previous bleeds, etc., was treated conservatively in the same manner, except that they received either no hemodynamically active drugs or short acting neurohypophysial peptide preparations such as Pitressin. In the control group there was a 61.5% total mortality, a 53.8% mortality directly related to uncontrollable bleeding, and a mean duration of the bleeding episode of 11 days. In the tGLVP-treated group total mortality was 20%, mortality directly related to uncontrollable bleeding was 13.3%, and mean duration of the bleeding episode was 2.9 days. These results appear to justify a large scale clinical trial of the vasopressin hormonogen in this disease.