Phenylketonuria is a rare genetic disorder that causes cognitive impairment unless treated with a strict, protein-restricted diet. Due to the challenges of treatment adherence, caring for a child with PKU may affect parental wellbeing, and many children and adolescents have poor metabolic control. The overall aim of the thesis was to examine influences on parental wellbeing and treatment adherence. Paper 1 is a systematic literature review of the demographic and psychosocial influences on blood phenylalanine concentration for children and adolescents with PKU. The aim was to identify factors that were robustly linked with metabolic control and could potentially be used to inform clinical practice. Findings from 29 identified studies indicated that whilst a number of demographic and psychosocial factors were related to metabolic control, the most reproducible association was with child age. Quality assessment of the studies indicated some methodological limitations, and a paucity of research in some areas highlighted the need for further research. The limitations of the evidence-base, clinical implications, and directions for future research are discussed. Paper 2 presents an investigation of the psychological impact of parenting a child with PKU, the determinants of parental wellbeing, and the association between parental wellbeing and treatment adherence. Forty-six caregivers of children with PKU completed questionnaires examining psychological distress, parenting stress related to caring for a child with an illness, resilience, perceived social support, and child dependency. The proportion of blood phenylalanine concentrations within target range in the preceding year was used a measure of treatment adherence. Results showed that more than half of caregivers had clinical levels of psychological distress, which was predicted by their parenting stress and resilience. Whilst treatment adherence was not associated with parental distress, it was predicted by child age and caregiver perceived support from family. The limitations of the study, implications for clinical practice, and future research directions are discussed. Paper 3 provides a critical evaluation of Papers 1 and 2 and a personal reflection of the research process.

Introduction: The fight against HIV is addressed in both the Sustainable Development Goals and in the 90-90-90-goals set by the United Nations.Emerging evidence is suggesting a “neglected interface” between alcohol consumption and HIV. Earlier studies has sought out to quantify this relationship, but there are still uncertainties regarding the generalizability of the results and if this also applies to different types of drinking intensities. Methods: This study applied a systematic search for articles published between 1990-2017 in Pubmed/Medline. 46 studies was included in the final analysis. Results: Alcohol was found to have a significant detrimental effect on treatment adherence on all drinking intensities. All but one analysis showed a significant amount of heterogeneity. Conclusion: The findings of this study goes in line with previous research but adds insight on the harm of moderate drinking. The result of this and earlier findings give a clear point of direction of alcohol consumption guidelines in people living with HIV. If global targets of viral suppression should be achieved, a more holistic approach where the prevention of non-communicable diseases and infectious diseases go hand in hand might actually be the only way forward.

Homework assignments that patient work with between sessions is a key component in both face-to-face and Internet-based Cognitive Behavior Therapy (CBT). However, adherence to assignments is often low and it is largely unclear what factors predict or affect treatment adherence, and in the end, treatment outcomes. The overall aim of this thesis was to investigate if treatment presentation and therapist support can affect adherence and treatment outcome in internet-based CBT, whether adherence can be predicted by motivation variables and to compare differences in face-to-face and online conditions in this regard. A randomized controlled trial with a brief online relaxation program for people with stress and anxiety symptoms was conducted (n = 162). Participants in the enhanced support conditions completed a larger proportion of the online treatment but adherence was not affected by enhanced treatment presentation (Study I). Participants reported reduced symptoms of stress and anxiety after the relaxation program but there were no significant additional effects of enhanced presentation or support (Study II). Participants who adhered to the prescribed assignments reported lower symptom levels at study end, regardless of treatment conditions. Adherence to the online treatment was predicted by subject factors such as treatment credibility prior to the treatment and intrinsic motivation during the treatment (Study III). To further elucidate how motivation may affect adherence, an experiment with a one-session psychotherapy model was subsequently conducted (n = 100). Participants who were randomized to the face-to-face condition reported higher motivation for the assignment and completed significantly more of the homework compared to participants in the online condition (Study IV). Self-reported intrinsic motivation could predict adherence in both conditions while new motivational variables were identified specifically for the online condition. The results from these studies confirm that adherence to assignments in Internet-based CBT is difficult to affect with treatment features but can be predicted early in treatment by subject factors such as treatment credibility and motivation. How such motivational variables can be affected to improve treatments is still unclear.

INTRODUCTION: In psychosis, low engagement with mental health services is both prevalent and frequently associated with negative outcome. The overarching objective of this thesis was to investigate the role of psychological variables in service engagement in people with psychosis. A systematic review was conducted to examine the evidence for clinical and psychological correlates of engagement. An empirical study sought to investigate the association between engagement and psychological variables of a relational nature (i.e. mentalizing and interpersonal functioning). METHODS: A systematic search strategy across four electronic databases yielded seventeen journal articles. For the empirical study, forty-two people with multiple-episode psychosis completed self-report measures of service engagement, symptoms, mentalizing and interpersonal functioning, within a cross-sectional design. RESULTS: The review found relatively robust evidence supporting the association between engagement and numerous clinical variables. Eleven psychological variables were revealed as significant correlates of service engagement, encompassing developmental, individual and relational factors. Assessment of quality and risk of bias highlighted a number of limitations within included studies. In the empirical study, greater cognitive/disorganization symptomology was predictive of lower service engagement. Service engagement was significantly correlated with mentalizing, but not with interpersonal functioning. The relationship between cognitive/disorganized symptomology and engagement was not mediated by mentalizing performance. CONCLUSION: Numerous psychological variables are associated with service engagement, which has the potential to inform clinical practice in view of enhancing engagement. Qualitative and longitudinal studies with both service user and provider samples are required to capture the contextual information surrounding fluctuations in levels of engagement.

Haiti reports the second highest prevalence of HIV among the Caribbean nations. People living with HIV/AIDS (PLWH) report stigmatic experiences, inadequate social support, depression, and anxiety, thereby affecting treatment adherence. This study examined the relationship between HIV-related stigma and treatment adherence, considering the effects of depression, anxiety, social support, and coping. The current study is a secondary analysis of baseline data collected from 362 PLWH from Haiti. The measures included: Community Programs for Clinical Research on AIDS (CPCRA) adherence questionnaire; Perceived Stigma scale; Brief COPE questionnaire; State-Trait Anxiety Inventory (STAI); Centers for Epidemiological Studies Depression Scale (CES-D); and modified Medical Outcome Study Social Support Survey (mMOS-SSS). Descriptive statistics were used for demographic characteristics. T tests, Person correlations, multivariable linear regressions and structural equation modeling (SEM) were used for estimating the strength of associations and mediating effects. Mean age of the sample was 35.72±8.50 years and 37.0% were men. The mean self-reported treatment adherence was 93.1 percent. About 50.2% reported high levels of perceived stigma, 58.1% reported high levels of social support, 51.1% reported high levels of coping, 45.6% reported depression and 47.2% reported anxiety. Multivariable regression showed that treatment adherence was directly associated with quality of care satisfaction scores (Beta = .032, p = .041) and inversely associated with perceived stigma (Beta = -0.049, p = .031). Depression was directly associated with perceived stigma-public view (Beta = 1.877, p = .037) and inversely associated with tangible/informational social support (Beta = 1.877, p = .020). SEM analyses showed significant associations between perceived sigma and coping (Beta = .175, p = .003), perceived sigma and anxiety (Beta = .164, p = .005), coping and anxiety (Beta = .229, p In summary, HIV-related stigma was associated with lower levels of treatment adherence, and higher levels of depression and anxiety. These findings could be informative for future large scale studies on stigma, coping, anxiety and depression and planning effective interventions for improving treatment adherence.

BACKGROUND: Adherence to TB treatment and therefore treatment success could be improved using digital adherence technology. OBJECTIVE: To evaluate the effectiveness of a medication event reminder monitor system (MERM) on treatment success and treatment adherence in patients with drug-susceptible pulmonary TB in Perú. METHODS: This was an experimental, randomised, open-label, controlled study conducted among patients in the second phase of TB treatment. The intervention group received their medications through MERM with the support of a treatment monitor, whereas the control group used the usual strategy. Participants were followed until they completed the 54 doses of the second phase of treatment. RESULTS: The study included 53 patients in each group; four in the intervention group withdrew from the study. Treatment success was significantly more frequent in the MERM group (RR 1.15, 95% CI 1.02–1.30; P = 0.0322). There was no significant difference in the adherence outcomes; however, the percentage of patients who missed at least one dose and patients with more than 10% of total doses missed were lower in the intervention group. CONCLUSION: The use of MERM in the second phase of treatment showed a significant improvement in the treatment success rate in patients with drug-susceptible pulmonary TB. / National Institutes of Health / Revisión por pares

No description available.

The field has developed many evidence-based treatments (EBTs); the integrity of EBTs being delivered, however, has been studied less than rigorously. Because many treatment manuals are developed to be delivered session-by-session, one way to assess treatment adherence, specifically, is across the course of the case: do therapists deliver treatment components in the order prescribed? The goals of this study were to characterize how therapists deviate from prescribed order and how adherence to order relates to child characteristics. Therapy process data were collected from a subsample of children (N = 33, aged 7-15) that received cognitive behavioral therapy (CBT) to address primary symptoms of anxiety. Adherence to CBT was measured by the CBT Adherence Scale for Youth Anxiety (Southam-Gerow & McLeod, 2011). Four methods to assess order were developed. Analyses include descriptive and correlative statistics that characterize the delivery of CBT and the relation between adherence to order and pretreatment characteristics.

Adolescent obesity has increased exponentially over the past three decades in the United States. In response, behavioral interventions have been developed and implemented to address this epidemic; however, treatment adherence is often suboptimal. Motivational interviewing (MI) is a directive, person centered approach to reducing patient ambivalence about change, which has been shown to increase engagement in obesity interventions. The current study investigated the underlying process of MI by exploring two different, but related pathways that explain how change happens (e.g., the technical and relational hypotheses) in the context of a multidisciplinary obesity intervention with African American adolescent girls (N = 30). Results demonstrated that MI-consistent skills were associated with client “change talk,” or language consistent with their desire, ability, reasons, need, taking steps or commitment to change. Specifically, clinician reflection of client change language and support of client autonomy were especially important for increasing change language. Furthermore, client language related to change was associated with three-month treatment adherence, and increased fruit and vegetable intake. However, the clinician’s ability to embody the MI “spirit” was not related to either client language or three-month treatment adherence. Findings suggest that the technical aspect of MI helps explain this approach's effects on treatment adherence among African American girls with obesity.

RESUMO Introdução: Nas últimas décadas a ideia limitada de que o tratamento para o Transtorno Afetivo Bipolar (TAB) consiste apenas em encontrar a medicação \"certa\" tem sido amplamente dissipada. A complexidade clínica dessa doença e os diferentes graus de adesão à farmacoterapia, demanda a utilização de opções terapêuticas variadas. Entre as alternativas para suprir essa demanda, tem-se combinado ao tratamento farmacológico uma abordagem psicoeducacional como opção eficaz no tratamento dos indivíduos com TAB. O uso da psicoeducação em formato de grupo tem sido frequentemente utilizada em vários estudos com bons resultados, porém a Psicoeducação Domiciliar ainda não foi avaliada e tal formato não tem sido aplicado em ensaios controlados até o momento. Objetivo: o objetivo deste estudo foi avaliar a eficácia da Psicoeducação Domiciliar em pacientes com Transtorno Afetivo Bipolar, em tratamento farmacológico padrão, realizada em suas residências. Metodologia: Tratase de um estudo randomizado controlado com 30 pacientes portadores de TAB tipo I ou II, de acordo com os critérios do DSM-IV TR; eutímicos com pontuação 8 na Escala de Depressão de Hamilton (HAM-D) 17 itens e 6 na Escala de Mania de Young (YOUNG). A distribuição dos sujeitos em dois grupos foi feita por meio de randomização estratificada. O grupo experimental (GE) composto de 15 pacientes recebeu além do tratamento farmacológico, visitas domiciliares com intervenção psicoeducacional. O grupo controle (GC) composto de 15 pacientes recebeu, além do tratamento farmacológico, visitas domiciliares placebo, sem intervenção psicoeducacional. Ambos os grupos receberam visitas semanais totalizando 8 sessões, com 90 minutos de duração cada uma. Os instrumentos de avaliação foram a escala de HAM-D para sintomas de depressão, e YOUNG, para a mania. As escalas para avaliar a recuperação funcional foram: WHOQOL-Bref e Escala de Adequação Social (EAS). Utilizou-se para avaliar a adesão medicamentosa a Escala de Adesão Medicamentosa (EAM) e o Teste de Morisk e Green. Resultados: Com relação à avaliação sintomática não houve recaída em ambos os polos, maníaco e depressivo, durante o estudo, somente uma diminuição nos escores da escala de HAM-D no grupo experimental ao longo do tempo (p<0,01). Na escala de YOUNG não houve uma diferença significativa entre os tempos e entre grupos (p=0,20). Na avaliação funcional as médias se mantiveram ao longo do tempo na escala EAS (p=0.08) e na escala WHOQOL-bref. Contudo em relação à adesão medicamentosa, no início do estudo a média de adesão no grupo experimental era 60% avaliada pela escala de Morisky e Green, no final do estudo houve um aumento dessa aderência para 93.3% (p=0.03). Na avaliação da Adesão Medicamentosa pela EAM o grupo experimental teve um aumento significativo nas médias ao longo do tempo (p<0,001), confirmando um aumento importante na adesão medicamentosa. Conclusão: Os dados demostraram que uma abordagem Psicoeducacional Domiciliar Breve de 8 sessões realizada em pacientes com TAB teve um impacto significativo na melhora da adesão medicamentosa. Não foi observado impacto funcional, pois as médias das escalas de avaliação funcional não se alteraram significativamente durantes o estudo em ambos os grupos. Não foi possível avaliar o impacto clínico da psicoeducação na sintomatologia afetiva destes pacientes, pois desde o início do estudo, eles permaneceram eutímicos, sem recaídas depressivas nem maníacas. A Psicoeducação Domiciliar demonstrou sua eficácia como abordagem psicossocial melhorando a adesão ao tratamento dos pacientes com TAB. / ABSTRACT Introduction: In last decades the restricted idea for Bipolar Disorder (BD) treatment was only to find the \"right\" medication has been largely dispelled. The clinical complexity of this disease, and the different levels of adherence to pharmacotherapy, demands the use of diverse therapeutic options. Among the alternatives to answer this demand, it has combined to pharmacological treatment to psychoeducational approach as an effective option in the treatment of individuals with BD. The use of psychoeducation in group has often been used in several studies with good results, but the Home Visit Psychoeducation at patients homes has not been evaluated and this format has not been applied in controlled trials to current. Objective: To evaluate the effectiveness of Home Visit Psychoeducation in patients with bipolar affective disorder in standard pharmacological treatment. Methodology: This is a randomized controlled trial with 30 patients with bipolar I or II, according to the DSM-IV TR, with score 8 on the Hamilton Depression Rating Scale (HAM-D) - 17 items 6 and the Young Mania Rating Scale (YOUNG), follow up at Mental Health System of Ribeirão Preto. The patients distribution was made by stratified randomization, patients, were divided into stratified blocks according to gender, age, education and marital status. The experimental group (EG) consisting of 15 patients received in addition to pharmacological treatment, home visits with psychoeducational intervention. The control group (CG) composed of 15 patients received, in addition to pharmacological treatment, \"placebo\" home visits. It is understood by \"placebo\" home visits unstructured visits without psychoeducational intervention. Both groups received weekly visits in a total of 8 sessions with 90 minutes duration. The scales used to assess symptomatic recovery were: HAM-D for depression, and YOUNG for mania. The Scales to assess functional recovery were: WHOQOL-Bref and the Social Adjustment Scale (SAS). The Medication Adherence Scale (MAS) and the Test of Morisk and Green were used to assess medication adherence. Results: In relation to symptomatic assessment there was no relapse in both poles, manic and depressed during the study, only a decrease in scores on HAM-D in the experimental group throughout the time (p<0,01), not significant difference between groups (p=0,67). In YOUNG scale there was no significant difference between times and among groups (p=0,20). The scores of the functional assessment scale EAS remained throughout the time (p=0,08), the scale WHOQOL-bref there was no significant difference in the four domains. However in relation to medication adherence at the beginning of the study the average membership in the experimental group was 60% as assessed by Morisky and Green scale at the end of the study there was an increase this adherence to 93.3% (p=0,03). In the evaluation of the Medication Adherence EAM the experimental group had a significant increase in the average throughout the time (p<0,001), confirming a significant increase in medication adherence. Conclusion: Our data demonstrated that a Home Visit Psychoeducational in brief 8 sessions held in homes of patients with BD had a significant impact on improving medication adherence. There was no functional impact, the averages of functional assessment scales have not significantly changes during the study in both groups. It was not possible to assess the clinical impact of psychoeducation on affective symptomatology of these patients, because since the beginning of the study, they remained euthymic, without depressive relapses nor manic.