The use of active management of the third stage of labor to prevent PPH due to uterine atony should be expanded, especially in developing country settings.

Barriers to adherence are essential to address in an effort to ameliorate adherence difficulties and potentially reduce the incidence of medical complications.

The aim of this study was to identify barriers to medication adherence in adolescent transplant recipients. Eighty adolescent transplant recipient families reported in an open-ended manner about barriers to medication adherence. These responses were then coded to reflect potentially important themes associated with medication adherence. The themes derived included: forgot/distracted, poor planning/scheduling issues, physical barriers/medication issues, and voluntary resistance/attempts to be normal. Inter-rater reliability for barrier coding was very high (k = 0.91). Patients who were classified as non-adherent reported significantly more overall barriers, more forgot/distracted barriers, and more voluntary resistance/attempts to be normal barriers than those classified as adherent. Non-adherence was also found to be more likely when adolescents, as opposed to parents, were responsible for administering the medication. Further, non-adherence was more likely when taking morning rather than evening doses. These findings are explained with an emphasis on potential remedies that directly address the stated barriers.

Overall, preliminary support suggests that programmatic psychosocial interventions for reducing physical symptoms and improving coping may be beneficial for adolescents with IBD and their families.