Patient adherence is the extent to which an individual follows the treatment regimen that was prescribed during a medical visit. It is estimated that 25 percent to 50 percent of patients are nonadherent, with varying rates across different conditions and treatment regimens. Nonadherence is a widespread problem and can negatively influence health outcomes, including disease progression and worsening of symptoms. In addition to negatively influencing health, nonadherence can also be costly. It is estimated that several hundred billion dollars spent on health care annually in the United States is due to nonadherence. Many different factors play into whether a patient is adherent, including complexity of the regimen, side effects, mental health, level of social support, and cost. A significant factor that is known to influence adherence is the quality of provider-patient communication. Health-care providers play an important role in promoting adherence for their patients, through educating patients about their disease and regimens, sharing decisions about the course of treatment with the patient, conveying the important implications of adherence, and providing support when patients face barriers to adherence. Communication during the medical visit plays an important role in determining whether a patient will adhere. This article will provide an overview of the literature on communication and adherence, focusing on topics such as information giving, shared decision making, nonverbal communication, trust, empathy, patient-centered communication, and health literacy.
The Bay St. George sub-basin of SW Newfoundland, part of the larger late Paleozoic Maritimes basin, formed under the influence of strike-slip faulting and the movement of evaporites. New stratigraphic correlations between Newfoundland and other late Paleozoic sub-basins illustrate the effects of both basement and salt movement. Coastal outcrops show complex combinations of synsedimentary, salt-related, and tectonic structures. Map relationships and dramatic thickness contrasts in the Tournaisian Anguille Group indicate that a large, concealed, NE–striking normal growth fault (Ship Cove fault) controlled sedimentation; the exposed Snakes Bight fault originated as a hanging-wall splay. Structures formed during, or soon after deposition include soft-sediment folds, boudins, clastic dykes, and millimetre-scale diapiric bulb structures, formed by overpressuring and liquidization of sediment. These suggest that the sub-basin was tectonically active throughout deposition. Evaporite-related deformation is recorded in the Visean Codroy Group and overlying strata. Comparisons between outcrop and subsurface suggests that significant amounts of evaporite were removed from exposed sections by halokinesis and solution. Complex outcrop relationships indicate salt welds, and suggest that units of the upper Codroy and overlying Barachois groups represent fills of minibasins that subsided into thick evaporites. Field relationships suggest tectonic inversion deposition related to E-W dextral strike slip motion that affected the entire Maritimes basin in the Serpukhovian, producing reverse-sense offsets and contractional folds. Many of the structures in the Bay St. George sub-basin, previously interpreted as post-depositional and purely tectonic, were formed by deformation of unlithified sediment and ductile evaporites during basin development.
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