Noncompliance in Adolescents

Cromer, Barbara A.; Tarnowski, Kenneth J.

doi:10.1097/00004703-198908000-00010

Cited by 74 publications

(47 citation statements)

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“…The causes of non-adherence are often unknown and may be due to the different lifestyles of the parents, including socioeconomic status, academic level and type of relationship with the child's physician. Other factors influencing adherence include the complexity of treatment regimens, long-term nature of the therapy and discomfort or pain associated with injections [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Adherence to Growth Hormone Therapy: A Practical Approach

et al. 2014

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Background: Early detection of suspected poor adherence to growth hormone (GH) therapy is crucial to achieve normal final height in GH-deficient (GHD) patients. Patients: 106 children (73 M, 33 F) with a median age of 10.47 ± 3.48 years (mean ± standard deviation score (SDS)) exhibited short stature (-1.76 ± 0.64 SDS) and a delayed bone age (8.68 ± 3.42 years). Severe GHD was found in 28, while partial GHD was seen in 78 cases, with low IGF-I values. Recombinant human GH was administered by daily subcutaneous injection at a dosage of 21 µg/kg in prepubertal and 25 µg/kg in pubertal patients. Results: Poor adherence was suspected in a number of patients, but clearly demonstrated in only 4 cases with persistent reduced height velocity in spite of a corrected therapeutic regimen. These patients admitted incomplete adherence to GH injections and clinical and anthropometric measurements revealed their poor response to therapy. Conclusions: To efficaciously improve adherence in GHD patients, it is mandatory to regularly interview patients; a non-aggressive approach might be utilized to ensure effective communication with patients and their parents.

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Section: Introductionmentioning

confidence: 99%

Adherence to Growth Hormone Therapy: A Practical Approach

et al. 2014

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“…4 At present, effective treatment techniques are not always beneficial or applicable. 5 We present a novel hypothesis that conceptualizes nonadherence, in some cases, as linked to symptoms of posttraumatic stress disorder (PTSD), which is a psychiatric disorder originally linked to combat experience. PTSD is a dysfunctional response to severe stress that is characterized by 3 clusters of symptoms.…”

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confidence: 99%

A Pilot Study of Posttraumatic Stress and Nonadherence in Pediatric Liver Transplant Recipients

et al. 2000

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ABSTRACT. Background. Symptoms of posttraumatic stress disorder (PTSD) were described in survivors of life-threatening diseases, the trauma being the experiences associated with the disease or its treatment. Their prevalence in liver transplant recipients is unknown. Based on clinical observations, we hypothesize that a significant proportion of pediatric liver transplant recipients suffers from PTSD symptoms. We further hypothesize that nonadherence (noncompliance) to medical management may, in some cases, be associated with these symptoms. Traumatized patients, according to this hypothesis, will avoid taking their medications, because these serve as painful reminders of the disease.Objectives. To determine the prevalence of PTSD symptoms in a sample of pediatric liver transplant recipients. To determine whether symptoms of PTSD are associated with nonadherence in these patients. To describe the clinical presentation of PTSD and the management of severe nonadherence in patients who suffer from this disorder.Methods. Nineteen pediatric liver transplant recipients and their caretakers were interviewed, using the UCLA Post Traumatic Stress Disorder Reaction Index (PTSRI). Data were obtained on a few demographic parameters and perception of disease threat. Adherence was evaluated by 2 methods: 1) a clinician panel (taking into account the clinical sequelae of severe nonadherence); and 2) computation of the standard deviations (SDs) of consecutive determinations of blood levels of Tacrolimus (a higher SD means higher variability between individual measures and is therefore an indicator of nonadherence). As an illustration of the general phenomenon, we describe 3 cases of liver transplant recipients who were nonadherent and who suffered from PTSD.Results. Six of 19 patients had positive scores on all 3 components of the PTSRI (PTSD patients). Three of these, and none of the others, were considered significantly nonadherent by the panel. Therefore, nonadherence was significantly associated with the existence of symptoms from all 3 domains of PTSD (Fisher's exact test) in our sample. In particular, a high avoidance score on the PTSRI was highly correlated with panel-determined nonadherence. Further, SD of medication levels were significantly higher in PTSD patients, compared with the rest of our sample. No significant differences were found in perception of disease threat or demographic variables between PTSD patients and the rest of our sample. The 3 cases that we describe became adherent to their medications when symptoms of PTSD subsided during the course of therapy.Conclusions. Clinically significant nonadherence, determined by 2 different methods, was associated with the full spectrum of PTSD symptoms in this sample. It was especially associated with a high avoidance score, which suggests that avoidance of reminders of the disease (eg, medications) may be a mechanism of nonadherence. Screening for and management of these symptoms, therefore, may improve adherence. This novel concept may be applicable to other pati...

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“…The causes of non-adherence are often unknown and may be due to the diferent lifestyles of the patients, including socio-economic status, level of understanding and type of relationship with the child's physician. Other factors inluencing adherence include the complexity of treatment regimens, the long-term nature of the therapy and the discomfort or pain associated with injections [83,88]. In order to eicaciously improve adherence in GHD patients, appropriate pre-intervention discussion is essential, and should include a clear statement of the short-and long-term treatment targets.…”

Section: Adherence To Gh Therapymentioning

confidence: 99%

Growth hormone deficiency: diagnosis and therapy in children

Bozzola¹,

Meazza

2010

Expert Review of Endocrinology & Metabolism

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Short stature has been deined as a height below the 2 standard deviation for age, sex and ethnicity. Growth hormone deiciency (GHD) represents a condition characterized by reduced GH secretion, isolated or associated with other pituitary hormone deiciencies. In a child with short stature and growth deceleration, after the exclusion of other causes of growth failure, the diagnosis of GHD has to be conirmed by measurement of GH secretion after at least two stimulation tests. Patients with GHD should be treated with rhGH as soon as possible, to obtain normalization of growth and normal inal height. The catch-up growth in response to rhGH therapy is maximal during the irst years and could be afected by many variables, such as birth-weight, age and height at start of treatment and of puberty, and duration of treatment. Overall, rhGH is believed to be safe and signiicant side-efects in children are very rare, including benign intracranial hypertension, hyperglycaemia, arthralgia and myalgia. Patients with childhood onset GHD are usually retested in late adolescence to conirm the GHD persistence and to continue of GH therapy. In conclusion, the present chapter provides useful and updated information about the diagnosis, treatment and follow-up of children with GHD.

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Noncompliance in Adolescents

Cited by 74 publications

References 0 publications

Adherence to Growth Hormone Therapy: A Practical Approach

Adherence to Growth Hormone Therapy: A Practical Approach

A Pilot Study of Posttraumatic Stress and Nonadherence in Pediatric Liver Transplant Recipients

Growth hormone deficiency: diagnosis and therapy in children

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