The Role of Digital Technology and New Strategies in Engagement and Adherence Among Patients With Cardiometabolic Disease

Abstract This article explores challenges and barriers to managing cardiometabolic conditions, highlighting strategies and technologies for improving patient adherence. Approaches such as simplifying prescriptions, patient empowerment, health education, setting short-term goals, understanding social context, self-monitoring, and gamification have been effective in promoting adherence. The use of health apps for chronic diseases has also been increasing, facilitating medication adherence and self-monitoring. Integrating these approaches into clinical practice can lead to consistent outcomes and reduce care-associated costs.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

Introducción: desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. Objetivos: conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. Métodos: estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. Resultados: se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). Discusión: la mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.

Background: since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. Aim: to study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. Methods: we conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. Results: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). Discussion: most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.

Factores que influyen en la adherencia a la vacuna contra la tosferina en mujeres embarazadas en Uruguay / Factors that influence the uptake of pertussis vaccine in pregnant women in Uruguay

INTRODUCCIÓN: Desde 2015 se ofrece la vacunación contra tosferina de modo universal y gratuito a mujeres embarazadas del Uruguay. Si bien es obligatoria, la cobertura vacunal, aún no es completa. OBJETIVOS: Conocer la prevalencia de mujeres embarazadas de dos hospitales públicos de Uruguay que recibieron vacuna dpaT en 2017 y determinar posibles factores que influyen en la adherencia a vacunarse. MÉTODOS: Estudio observacional, transversal, descriptivo, mediante encuestas a pacientes cursando puerperio inmediato. RESULTADOS: Se analizaron 884 encuestas (edad promedio 25,2 años; 16% adolescentes; la mayoría en pareja y educación secundaria incompleta). Se vacunaron 317 mujeres (36%). Dentro de los factores que se asociaron a la no vacunación se destacan: adolescencia (OR 1,88; IC 95% 1,24-2,85), no tener pareja (OR 1,40; IC 95% 1,04-1,85), no conocer la obligatoriedad de la vacuna (OR 9,44; IC 95% 6,63-13,45), no haber sido informada sobre los beneficios de la vacuna (OR 4; IC 95% 2,43-6,41) y no creer en el beneficio de las vacunas en el embarazo (OR 6,37; IC 95% 4,61-8,78). DISCUSIÓN: La mayoría de las mujeres embarazadas no recibieron la vacuna dpaT ni tuvieron indicación médica. La falta de información sobre la obligatoriedad y su beneficio, y las creencias con respecto a la vacunación se asociaron a una disminución en la adherencia a la misma. Los profesionales de la salud que atienden mujeres gestantes deben recomendar e informar sobre el beneficio de la vacunación para ellas y el neonato y generar la percepción de riesgo necesaria, como una de las medidas para mejorar la cobertura vacunal.

BACKGROUND: Since 2015, pertussis vaccine has been offered universally and free of charge to pregnant women in Uruguay. Although it is mandatory, vaccination coverage is not yet complete. AIM: To study the pertussis vaccination coverage in 2017 in pregnant women in two state hospitals and to search for barriere for uptaking the vaccine. METHODS: We conducted an observational, descriptive and transversal study, using a survey in patients undergoing immediate postpartum period. RESULTS: 884 surveys were analyzed (mean age 25.2 years; 16% teenagers, most of them in a relationship and incomplete high school). 317 women (36%) were vaccinated. Main barriere for uptaking Tdap vaccine were: teenage and being single were associated with a greater risk for the uptake. Not being aware of the vaccine mandatoriness and not being informed about its benefits were associated with 9,44 and 4 higher risks for not uptaking the vaccine (IC 95% 6.63-13.45 and IC 95% 2.43-6.41, respectively). Not believing in the benefits of pertussis vaccine during pregnancy was associated with 6.37 higher risk (OR 6.37; IC 95% 4.61-8.78). DISCUSSION: Most pregnant women in this study during 2017 did not uptake pertussis vaccine and did not have medical indication for it. The lack of information about the obligation and benefits, and also patients' beliefs about the vaccination were identified as barriere. Health professionals who treat pregnant women should recommend and inform about the benefits of pertussis vaccine for women and the infant, and create the necessary perception of risk, in order to improve the vaccination coverage.

Patients Adherence to Physiotherapist Prescribed Self-management Strategies: A Physical Therapist’s Perspective

Background:Few studies have been done in India about factors which can influence patient’s adherence to self-management protocol and a physiotherapist’s view on subject of adherence.Material & Methods:This cross-sectional study was conducted via a self-made questionnaire consisting of 20 items. Fifty final BPT and 1styear post graduate students were asked to choosethemost appropriate answer from options given. Descriptive analysis was done using Google Forms.Results:62% strongly agreed that self-management is important. Good self-management strategies should have clarity of instructions (66%), beproper and should be easy to follow (50%). 86% believed proper communication skills, strategy prescription, knowledge, monitoring and follow up by therapist will help patient adhere to strategies. Willingness to exercise (48%), Positive belief in exercise(44%) and Age(56%) were thought to influence patient adherence. Stigma associated with disability (52%), poor inter-professional relation (86%), are barriers. Properly educating the patient about his condition(96%), involving the family members(92%) were believed to be facilitators. 46% therapists agreed that a passive approach should not be used. 54% strongly disagreed they don’t have time to assess patient adherence.Conclusion:Physiotherapists agree that patient’s adherence to physiotherapist prescribed self-management strategies is essential for clinical practice. There is a need to use different approaches to increase patient adherence.

Comportamento alimentar em obesos e sua correlação com o tratamento nutricional / Eating behavior in obesity and its correlation with nutritional treatment

RESUMO Objetivo Avaliar os tipos de comportamentos alimentares em indivíduos com obesidade e correlacionar com a adesão ao tratamento proposto. Métodos Estudo transversal desenvolvido em instituição de cardiologia em indivíduos com obesidade. Os tipos de comportamentos alimentares foram analisados pela escala The Three Factor Eating Questionnaire - R21 (TFEQ-21) - versão traduzida e adaptada para brasileiros. Nela são abordadas três subescalas: restrição cognitiva (RC), alimentação emocional (AE) e descontrole alimentar (DA). A adesão ao tratamento nutricional foi verificada pelo instrumento desenvolvido pela instituição, baseado nas principais diretrizes de doenças crônicas. Resultados Analisaram-se 100 indivíduos, com maior prevalência do sexo feminino (68%). Em relação à adesão, somente 25% apresentam boa aderência (escore > 60%). Foi possível identificar a relação entre o IMC e a RC; quanto maior o IMC, menor foi a intensidade da RC (p = 0,02). Observou-se correlação positiva entre a RC e adesão ao consumo de gorduras (p = 0,02) e fibra alimentar (p = 0,004). A subescala AE apresentou correlação negativa com a adesão ao consumo de gorduras (p = 0,03) e correlação positiva com a DA (p < 0,01). Conclusões O tipo de comportamento alimentar mais frequente na amostra foi a restrição cognitiva, que não foi correlacionada com o escore total de adesão. A AE foi associada com maior consumo de gorduras, similar ao encontrado em estudos nacionais e internacionais. Nota-se uma lacuna de estudos que relacionam o comportamento alimentar com a adesão ao tratamento nutricional.

ABSTRACT Objective To analyze the types of eating behavior in individuals with obesity and correlated with adherence to the adopted treatment. Methods Cross-sectional study developed at the institution of cardiology in individuals with obesity. The types of eating behavior were analyzed using the scale The Three-Factor Eating Questionnaire - R21 (TFEQ-21) - translated and adapted for Brazilians. Three subscales are addressed: cognitive restriction (CR), emotional eating (EE), and uncontrolled eating (UE). Adherence to nutritional treatment was verified by the instrument developed by the institution, based on the main guidelines for chronic diseases. Results We analyzed 100 individuals, with a higher prevalence of females (68%). Regarding adherence, only 25% have good adherence (score > 60%). It was possible to identify the relationship between the BMI and the CR, the higher or lower the BMI was the intensity of the CR (p = 0.02) There was a positive correlation between CR and adherence to fat (p = 0.02) and dietary fiber (p = 0.004). The EE subscale showed a negative correlation with adherence to fat consumption (p = 0.03) and a positive correlation with UE (p < 0.01). Conclusions The most frequent type of eating behavior in the sample was cognitive restriction and was not correlated with the total adherence score. AE was associated with greater consumption of fats, like national and international studies. There is a gap in studies that relate to eating behavior with adherence to nutritional treatment.

Abordagem dietética para controle da hipertensão: reflexões sobre adesão e possíveis impactos para a saúde coletiva / A dietary approach to control hypertension: reflections on adherence to and possible impacts on public health

Resumo A dieta DASH (Dietary Approach to Stop Hypertension) é considerada um padrão alimentar saudável, sendo preconizada para o controle da hipertensão arterial. O objetivo do artigo foi revisar a literatura sobre a dieta DASH e verificar sua adesão pela população brasileira. Realizou-se revisão integrativa nas bases Medline/PubMed, SciELO e LILACS, nos idiomas inglês e português. A literatura sobre dieta DASH é extensa, entretanto quatro estudos mostrando a adesão pela população brasileira foram encontrados. A dieta DASH representa uma intervenção potencialmente acessível e aplicável que poderia melhorar a saúde da população. Os estudos diferiram entre si nos métodos de avaliação utilizados e a baixa adesão evidencia a necessidade de implementação de ações no âmbito da atenção nutricional ao hipertenso. Estratégias inovadoras serão necessárias para determinar a melhor forma de minimizar as barreiras para disseminação e adesão a esse padrão alimentar saudável. Sugere-se planos alimentares e orientações flexíveis, pouco restritivas, compatíveis, com objetivos claros, direcionados para mudanças graduais, com monitoramento frequente de equipe multiprofissional de saúde.

Abstract The DASH (Dietary Approach to Stop Hypertension) diet is considered a healthy eating standard and has been recommended for the control of arterial hypertension. The scope of this article was to review the scientific literature regarding the DASH diet and to verify the adherence to this food standard by the Brazilian population. An integrative review of the literature in the Medline/PubMed, SciELO and LILACS databases was conducted in English and Portuguese. The literature on the DASH diet is extensive. However, only four studies showing adherence to the DASH diet by the Brazilian population were found. Findings from this review show that the DASH diet represents a potentially accessible and applicable intervention, which could improve the health of the population. The studies differed in the methods of evaluation. The low adherence to the diet in the Brazilian population reveals the need for nutritional actions to deal with hypertension. Innovative strategies are called for to determine how best to minimize the barriers to dissemination and greater adherence to this healthy food standard. Food plans and flexible, non-restrictive, compatible guidelines with clear objectives directed towards gradual changes with frequent monitoring by a multiprofessional health team, are suggested.

Depresión y adherencia en personas afectadas con tuberculosis: Una exploración preliminar de datos / Association between depression and the lack of adherence to antituberculosis treatment

Objetivo: Determinar la asociación entre depresión y la falta de adherencia al tratamiento antituberculoso en pacientes del Hospital Nacional Dos de Mayo (Lima, Perú) durante el año 2017. Material y Métodos: Estudio observacional, descriptivo y prospectivo en 50 pacientes con Tuberculosis que finalizaron la primera fase del Esquema Sensible de tratamiento. Se aplicó el cuestionario PHQ-9 para determinar depresión, y el cuestionario Morisky-Green para evaluar adherencia al tratamiento. Resultados: Se evaluaron 28 pacientes varones y 22 mujeres con diagnóstico reciente de TB pulmonar y estado nutricional normal más frecuente. El promedio de faltas fue 6.5%. Un 38% de pacientes fueron clasificados como no adherentes y la depresión estuvo presente en un 76%. Se determinó asociación estadísticamente significativa (p>0.05) entre niveles de adherencia y de depresión, según los instrumentos utilizados. Igualmente, se encontró asociación entre adherencia y tener 5 o más faltas durante la primera fase del tratamiento. Conclusiones: Existe asociación entre el nivel de adherencia al tratamiento anti-TB y la presencia de depresión. Asimismo, la elevada frecuencia de no adherencia al tratamiento en primera fase y la frecuencia elevada de síntomas sugestivos de depresión y la asociación entre adherencia y tener 5 o más faltas.

Objective: To determine the association between depression and the lack of adherence to antituberculosis treatment in patients treated at the National Hospital Dos de Mayo (Lima, Perú) in 2017. Material and Methods: Observational, descriptive and prospective study carried out in 50 TB patients who completed the first phase of the Sensitive treatment scheme. PHQ-9 questionnaire was applied to determine depression, and Morisky-Green questionnaire to evaluate adherence to treatment. Results: 28 male and 22 female patients with normal nutritional status, recently diagnosed with pulmonary TB were assessed. Average number of fouls was 6.5. 38% of patients were non-adherent, and depression was present in 76%., according to the instruments used. (p> 0.05). There was also a statistically significant association between adherence and having 5 or more faults during the 1st Phase. Conclusions: There is an association between adherence to anti-TB treatment and depression. Similarly, high frequency of non-adherence to treatment in the first phase and high frequency of symptoms suggestive of depression, and association between adherence and having 5 or more faults.

Representações dos participantes de uma intervenção psicossocial para melhoria da adesão ao tratamento da aids / Participants' representations of a psychosocial intervention to improve adherence to AIDS treatment / Representaciones de los participantes de una intervención psicosocial para mejorar la adhesión al tratamiento del SIDA

Este artigo apresenta a investigação e a análise qualitativas das representações construídas por 29 pacientes sobre a experiência de sua participação em uma intervenção psicossocial para melhoria da adesão ao tratamento antirretroviral, realizada em serviço de referência em DST/aids do estado de São Paulo (Brasil). Com o objetivo de apreender, compreender e explicar a relação entre o cotidiano dos pacientes e sua adesão ao tratamento, as entrevistas semiabertas de longa duração com eles realizadas buscaram investigar se, como e por que a experiência vivenciada durante a intervenção transformou a supracitada relação. A análise qualitativa resultante dessa investigação aponta que, ao oportunizar a conscientização sobre a importância do (auto)cuidado no uso prescrito e contínuo da medicação, a intervenção levou os pacientes a aprender formas próprias de inserir a adesão em seu cotidiano, podendo transformá-lo por meio da melhoria dessa adesão.

Este artículo presenta la investigación y el análisis cualitativo de las representaciones construidas por 29 pacientes sobre la experiencia de su participación en intervención psicosocial para mejorar la adhesión al tratamiento antirretroviral, realizada en servicio de referencia en EST/SIDA del estado de São Paulo (Brasil). Con objetivo de aprehender, comprender y explicar la relación entre el cotidiano de los pacientes y su adhesión al tratamiento, se realizaron entrevistas semiabiertas de larga duración para investigar si, cómo y por qué la experiencia vivida durante la intervención transformó tal relación. El análisis cualitativo resultante de esta investigación indica que, al brindarles la oportunidad de concientizarse sobre la importancia del (auto)cuidado en el uso prescripto y continuo de la medicación, la intervención condujo a los pacientes a aprender formas propias de introducir la adhesión en su cotidiano, para poder transformarlo mediante la mejora de esa adhesión.

This paper presents the qualitative investigation and analysis of representations constructed by 29 patients on the experience of their participation in a psychosocial intervention to improve adherence to antiretroviral treatment. The intervention was performed at a reference service in STD/AIDS of the State of São Paulo (Brazil). Long, semi-structured interviews were conducted with the patients in order to apprehend, understand and explain the relationship between the patients’ everyday life and their adherence to treatment, investigating if, how and why the experience lived during the intervention transformed this relationship. The resulting qualitative analysis indicates that, by raising the patients’ awareness of the importance of (self)care regarding the prescribed and continued use of medication, the intervention enabled the patients to learn their own ways of including adherence in their everyday life, and they may transform it through the improvement in this adherence.

Alta adesão aos medicamentos prescritos apesar de baixo comparecimento às reuniões de grupo entre pacientes do programa HIPERDIA / Alta adherencia a los medicamentos prescritos a pesar de baja asistencia a las reuniones de grupo entre los pacientes del programa HIPERDIA / High adherence to prescribed medications despite low attendance at group meetings of patients in the HIPERDIA program

Objetivo: O estudo teve por objetivo avaliar os índices de adesão às reuniões do grupo de hipertensos e diabéticos por meio do Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos (HIPERDIA), bem como o uso efetivo dos medicamentos da Unidade de Saúde da Família. Métodos: Durante o período de outubro de 2013 a março de 2014 foi realizado um estudo longitudinal e prospectivo, compreendendo uma coorte de pacientes de ambos os sexos, residentes na área de abrangência da Unidade de Saúde da Família São Francisco de Assis cadastrados no HIPERDIA. Os pacientes foram acompanhados durante as reuniões mensais nas comunidades, nas quais eram avaliadas as taxas de participação efetiva e a utilização das medicações por meio da checagem da saída mensal da medicação em estoque, vinculada ao paciente. Resultados: Dos 238 pacientes cadastrados no programa HIPERDIA, 226 deles (94%) aderiram ao tratamento, e 12 pacientes (6%) não utilizavam a medicação prescrita pelo médico da Unidade de Saúde. Apenas 34 pacientes (14,3%) participaram das reuniões e retiravam a medicação nos encontros do HIPERDIA. Outros 192 pacientes (80,7%) não participavam das reuniões e retiravam as medicações na Unidade de Saúde em algum momento durante o mês. Doze deles (5%) não participaram das reuniões nem retiraram a medicação junto à Unidade de Saúde. Conclusão: A adesão ao tratamento do diabetes e da hipertensão arterial sistêmica foi considerada satisfatória, apesar do baixo índice de participação dos grupos nas reuniões do HIPERDIA.

Objectives: The objectives of the study were to evaluate the rates of attendance at group meetings of patients with hypertension and diabetes mellitus, using the Registration and Monitoring of Hypertensive Diabetics System (HIPERDIA), and to evaluate the effective use of medications to treat these disorders, by means of monitoring patient collection of dispensed medication from the Family Health Unit. Methods: From October 2013 to March 2014, a prospective longitudinal study was conducted. The cohort comprised patients of both sexes, registered with HIPERDIA, and living in the area covered by the Family Health Unit São Francisco de Assis. Patients were followed up at monthly meetings in the community, where they were evaluated for effective participation rates and adherence to medications. The latter was done by reviewing the monthly dispensing of medication in stock, linked to individual patients. Results: Of the 238 patients enrolled in the HIPERDIA program, 226 (94%) adhered to treatment, while 12 (6%) did not. Only 34 patients (14.3%) enrolled to attend, and to collect their medication at, the HIPERDIA group meetings. The other 192 patients (80.7%) did not attend the meetings and collected their medications at the Health Unit at another time during the month. Twelve of these patients (5%) did not participate in meetings or collect their medications at the Health Center. Conclusion: Adherence to treatment for diabetes and hypertension was satisfactory despite the low rate of participation in HIPERDIA group meetings.

Objetivo: El objetivo del estudio fue evaluar las tasas de adherencia a las reuniones del grupo hipertensos y diabéticos a través del sistema de registro y control de los hipertensos y diabéticos (HIPERDIA), así como estimar el uso efectivo de los medicamentos utilizados en el tratamiento de la Diabetes Mellitus e Hipertensión arterial sistémica. Métodos: De octubre de 2013 a marzo de 2014 se realizó un estudio prospectivo longitudinal, que comprende una cohorte de pacientes de ambos sexos, que viven en el área cubierta por la Unidad de Salud de la Familia São Francisco de Assis, inscritos en el HIPERDIA. Los pacientes fueron acompañados durante las reuniones mensuales en las comunidades, en las que se evaluaban las tasas de participación efectiva y la utilización de las medicaciones utilizadas por el paciente, a través Del control de la salida mensual de los medicamentos del stock. Resultados: De 238 pacientes inscritos en el programa HIPERDIA, 226 de ellos (94%) adhirieron al tratamiento, y 12 pacientes (6%) no utilizaron la medicación prescripta por el por el médico de la Unidade de Salud. Sólo 34 pacientes (14,3%) participaron de las reuniones y recogieron la medicación em los encuentros HIPERDIA. Otros 192 pacientes (80,7%) no participaron de las reuniones y recogieron los medicamentos en la Unidad de Salud en algún momento del mes. 12 de ellos (5%) no participaron de las reuniones y tampoco recogieron los medicamento en la Unidad de Salud. Conclusión: La adherencia al tratamiento de la diabetes y de la hipertensión era satisfactoria a pesar del bajo índice de participación de los grupos en las reuniones HIPERDIA.

Adesão ao tratamento de diabetes Mellitus em área rural do município de Vitória de Santo Antão - PE / Adherence to treatment of diabetes Mellitus in a rural area of Vitória de Santo Antão - PE

Objetivo: Este estudo teve como objetivo avaliar a adesão ao tratamento de indivíduos com diabetes que residem em um distrito da zona rural do município de Vitória de Santo Antão ­ PE, sobretudo no que se refere ao uso de medicação, a dieta alimentar e a realização de atividade física. Método: Participaram do estudo 57 pessoas com diagnóstico confirmado de diabetes mellitus e cadastradas na Unidade de Saúde da Família do distrito de Pirituba, no ano de 2010. Os dados foram obtidos mediante entrevista com os participantes em seu domicílio. Utilizou-se um questionário semiestruturado. Foi composto um banco de dados no software Epi Info 3.5.1, em que foi realizada a análise univariada, buscando verificar a existência de diferenças entre os indivíduos que aderiram e os que não aderiram ao tratamento, utilizando o teste exato de Fisher com IC a 95% e valor de p de 0,05. Resultados: Os resultados mostraram que dos 57 indivíduos diabéticos, 10 (17,5%) aderem ao tratamento recomendado. Conclusão: A baixa adesão ao tratamento de diabetes mellitus revela a necessidade de um modelo de atenção individualizado, levando em consideração a cultura local dos portadores de doenças crônicas residentes em áreas rurais.

Objective: This study aimed to assess adherence to treatment of individuals with diabetes residing in a rural district in the city of Vitória de Santo Antão - PE, especially regarding the use of medication, diet and physical activity. Method: The study included 57 people with confirmed diagnosis of diabetes mellitus and registered with the Family Health Unit of the District of Pirituba in the year 2010. Data were collected through interviews with participants at their homes. We used a semi-structured questionnaire. It was composed of a database in Epi Info 3.5.1, where he performed univariate analysis seeking to verify the existence of differences between individuals who joined and those who did not adhere to treatment, using Fisher's exact test with 95% IC and p value of 0.05. Results: The results showed that among 57 diabetic patients, 10 (17.5%) adhere to the recommended treatment. Conclusion: Poor adherence to treatment of diabetes mellitus reveals the need for an individualized care model, taking into consideration local culture of chronic disease patients living in rural areas.

Effectiveness of Self-efficacy Promoting Vestibular Rehabilitation Program for Patients with Vestibular Hypofunction

PURPOSE: In this study an examination was done of the effect of self-efficacy promoting vestibular rehabilitation (S-VR) on dizziness, exercise selfefficacy, adherence to vestibular rehabilitation (VR), subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness in patients with vestibular hypofunction. METHODS: This was a randomized controlled study. Data were collected 3 times at baseline, 4 and 8 weeks after beginning the intervention. Outcome measures were level of dizziness, exercise self-efficacy, and level of adherence to VR. Subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness were also obtained. Data were analyzed using Windows SPSS 21.0 program. RESULTS: After 4 weeks of S-VR, there was no difference between the groups for dizziness, subjective and objective vestibular functions. However, exercise self-efficacy and adherence to VR were higher in the experimental group than in the control group. After 8 weeks of S-VR, dizziness (p =.018) exercise self-efficacy (p <.001), adherence to VR (p <.001), total-dizziness handicap inventory (DHI) (p =.012), vision analysis ratio (p =.046) in the experimental group differ significantly from that of the control group. The number of patients with recurring dizziness were higher in the control group than in the experimental group (p <.001). CONCLUSION: The results indicate that continuous 8 weeks of S-VR is effective in reducing dizziness, and improving exercise self-efficacy, subjective vestibular function and adherence to VR. Objective vestibular function and vestibular compensation were also improved in the experimental group at the end of 8 weeks of S-VR.

The Effects of Adherence to Non-Steroidal Anti-Inflammatory Drugs and Factors Influencing Drug Adherence in Patients with Knee Osteoarthritis

We aimed to compare the clinical outcomes of knee osteoarthritis patients according to drug adherence; and to find out the factors the affecting those outcomes. We analyzed the drug adherence and clinical outcomes in 1,334 primary knee osteoarthritis patients who took non-steroidal anti-inflammatory drugs (NSAIDs) for 3 weeks. Clinical outcomes of Pain Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS) and EQ-5D were compared at baseline and 3 weeks' follow-up between the two groups of adherent group and non-adherent group (1,167 vs. 167 patients). Logistic regression analysis was performed to examine the factors affecting the adherence, and the reasons for the non-adherence were asked. The follow-up clinical outcomes of NRS and KOOS symptom, pain and activity of daily life were significantly higher in the adherence group (P = 0.003, P = 0.048, P = 0.005, and P = 0.003, respectively). The adherence was better in the elderly and in the male group (P = 0.042 and P = 0.034, respectively) and the top reason for no strict adherence was "symptom improved" (21.5%) followed by side effects. In this study, the patients with better adherence to NSAIDs showed better outcomes compared to those with poor adherence. This study can contribute to the patient education for the pharmacological treatment in knee OA patients.

Mediating Effect of Self-Efficacy in the Relationship between Internalized Stigma and Treatment Adherence of Community Dwelling Patients with Mental Illness / 정신간호학회지

PURPOSE: This study was conducted to explore the mediating effect of self-efficacy in the relationship between internalized stigma and treatment adherence among community dwelling patient with mental illness. METHODS: A cross-sectional study design was employed. Participants were 145 people with mental illness who were enrolled at one of 11 community mental health institutions in Busan, South Korea. Internalized stigma of mental illness, self-efficacy, treatment adherence, and socio-demographic data were examined. Data were collected using self-report questionnaires and analyzed using Baron and Kenny method. RESULTS: Internalized stigma had a significant negative correlation with self-efficacy and treatment adherence. Self-efficacy had a significant positive correlation with treatment adherence. In addition, self-efficacy had a full mediating effect in the relationship between internalized stigma and treatment adherence. CONCLUSION: The results suggest that self-efficacy plays an important role in promoting treatment adherence among patients with mental illness who have high levels of internalized stigma. Therefore, mental health professionals should focus on reducing internalized stigma and also enhancing self-efficacy to increase treatment adherence for persons with mental illness living in the community.

The Impact of Low Adherence to the Low-iodine Diet on the Efficacy of the Radioactive Iodine Ablation Therapy

To improve the efficacy of radioactive iodine (RAI) therapy for differentiated thyroid cancer patients, a low-iodine diet (LID) prior to the therapy is recommended. In iodine-rich areas such as Korea, however, a strict LID is very difficult to maintain. We experienced the cases of three patients showing low adherence to the LID before initial RAI therapy, and analyzed the main food source supplying iodine during the LID, and examined the influence of the poorly maintained LID on the efficacy of RAI therapy. The dietary intake during the LID periods were assessed using three-day dietary records and remnant thyroid activity after the second RAI administration was also evaluated. All patients' mean daily iodine intake during two-week LID periods exceeded the 100 microg guideline set by the Korean Thyroid Association (median 110.9 microg, ranges 100.4-117.0 microg). Although the typical food sources of iodine intake are seaweeds in Korea, salted vegetables were the main contributor to the patients' iodine intake during the LID periods. Remnant thyroid activity was shown on a follow-up scan in all of 3 patients suggesting low efficacy of RAI therapy. In summary, the patients with low adherence to the LID guideline showed unsuccessful remnant ablation, and the main food source of iodine was salted vegetables. Further studies are necessary to examine the relationship between adherence of the LID and RAI efficacy according to dietary iodine intake levels, as well as food sources that cause low adherence to the LID. These data can then be used to develop more practical LID guidelines.

Contribuições do modelo biopsicossocial para adesão ao tratamento na obesidade / Contributions of the biopsychosocial model to adherence to treatment in obesity

O crescimento progressivo da obesidade aponta para a baixa eficácia das estratégias utilizadas em sua abordagem. A obesidade é um agravo multifatorial influenciada por determinantes sociais que requer mudanças no estilo de vida e no ambiente para seu tratamento. Ponderando que a mudança dos hábitos alimentares é considerada o componente de mais difícil adesão por parte dos pacientes, contribuições de diferentes aspectos que influenciam na adesão aos tratamentos de saúde, se fazem necessárias. Nesse sentido, observa-se que o aconselhamento nutricional pautado no modelo biomédico é pouco efetivo. Por outro lado, diversos autores vêm propondo estratégias educativas que permitam abordar os problemas alimentares em sua complexidade, tanto na dimensão biológica como na social e cultural e que envolve os pacientes como sujeitos ativos do processo. A partir dessas premissas o presente artigo discute a importância do modelo biopsicossocial para melhor adesão ao tratamento na obesidade e apresenta os principais modelos da Cognição Social como o Modelo de Crenças em Saúde, a Teoria da Ação Racional e o Modelo Transteórico. É necessário que os profissionais, o paciente, os serviços de saúde e as políticas públicas exerçam ações conjuntas para que os resultados do tratamento se apresentem de forma mais satisfatória.

The progressive growth of obesity points to the low efficacy of the strategies used for its approach. Obesity is a multifactorial health problem, influenced by social determinants, that requires changes in lifestyle and in the environment for its treatment. Considering that the change in eating habits is considered the component of most difficult adherence by patients, contributions of different aspects that may influence the adherence to health care, are necessary. In this sense, it is observed that nutritional counseling guided by the biomedical perspective has low efficacy. On the other hand, several authors have being proposing educational strategies so that eating problems can be approached in its complexity both in the biological and cultural ways, involving the patients as active subjects of the process. From these assumptions, the present article discusses the importance of the biopsychossocial model contributions for better adherence to treatment in obesity and presents the main models of Social Cognition such as the Health Belief Model, Theory of Reasoned Action and the Transtheoretical Model. It is necessary that professionals, patients, health services and public policy work together for the better results on treatment.

Patients’ Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE

Background: Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored. Methods: This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant. Results: A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated. Conclusion: The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.

Adherencia al tratamiento farmacológico en pacientes hipertensos del Hospital Comunitario de Yungay, 2012 / Adherence to pharmacotherapy of hypertensive patients of Yungay’s Communitarian Hospital, 2012

INTRODUCCIÓN: Las enfermedades cardiovasculares siguen siendo la principal causa de muerte en Chile. Entre ellas, la hipertensión arterial afecta a aproximadamente un tercio del país, pero solo un 45,9 por ciento de la población en tratamiento alcanza niveles normales de presión arterial. OBJETIVO: Determinar la adherencia al tratamiento farmacológico de un grupo de pacientes hipertensos en control en el consultorio del Hospital Comunitario de Yungay, mediante la aplicación del Test de Morisky-Green y analizar factores que podrían estar relacionados con el nivel de adherencia. MATERIALES Y MÉTODO: Estudio descriptivo prospectivo observacional en el que se entrevistó a pacientes atendidos en el consultorio del Hospital Comunitario de Yungay durante Agosto y Septiembre del 2012, utilizando el Test de Morisky Green y agregando otras preguntas en relación a género, edad, escolaridad, red de apoyo y número de medicamentos. Además, en todos los casos se midieron los niveles de presión arterial. RESULTADOS: Se incluyeron 74 pacientes. El 70,3 por ciento eran mujeres. El promedio de edad fue de 65,3 años. Solo un 45,9 por ciento presentó adherencia a tratamiento y un 47,9 por ciento obtuvo presión arterial bajo control. Entre los factores estudiados, el 51 por ciento tenía educación básica incompleta y el promedio de antihipertensivos fue de 1,75. DISCUSIÓN: La falta de adherencia a tratamiento tiene relación directa con el mal control de presión arterial, por lo que incrementar su investigación y educación en el seguimiento de los pacientes hipertensos debería ser uno de los principales objetivos de los programas cardiovasculares.

Introduction: Cardiovascular diseases are the main cause of death in Chile. Among them, High Blood Pressure or Hypertension or Arterial Hypertension affects about 1/3 of the country, but only 45.9 percent of the population under treatment reaches normal levels of blood pressure. Objective: determinate the adherence to treatment in a group of hypertensive patients from the Health Center of Yungay’s Communitarian Hospital, by using Morisky-Green Test, and analyze the factors that could be related to the level of adherence. Materials and methods: descriptive, observational and prospective study, perfomed by an interview of hypertensive patients from the Health Center of Yungay’s Communitarian Hospital between August and September 2012, using Morisky-Green Test and adding other questions related to gender, age, school level, support network and number of medications. Besides, blood pressure was taken to all patients. Results: 74 patients were included. 74 percent were women. The age average was 65.3 years. Only 45.9 percent had adherence to treatment and 47.9 percent had blood pressure under control. Within the studied factors, 51 percent of patients had primary educational level incomplete and the average of antihypertensive medications was 1.75. Conclusions and Discussion: The lack of adherence to treatment is directly related to a bad blood pressure control. An increment in investigation and education of the monitoring of hypertensive patients, should be one of the main goals of the cardiovascular programs.

Admissão e envolvimento terapêutico em saúde mental mão ou contramão de um mesmo processo? / Admission and therapeutic involvement in mental health: hand or against a single process?

Autonomia e louco, historicamente, nunca andaram lado-a-lado, quem dirá, de forma sincronizada. Entende-se por autonomia, a capacidade de um sujeito decidir, livremente, acerca das suas próprias ações e, portanto, delinear a sua trajetória de vida. Refletindo acerca dos conceitos de autonomia, crise e demanda, o modo como o portador de sofrimento psíquico é admitido, manifesta uma demanda dele ou de terceiros? Mesmo em crise, seria possível manifestar uma demanda vinculada à sua subjetividade e interações sociais. Se o usuário não chega ao serviço de modo autônomo, o projeto terapêutico pode relacionar-se a uma demanda que, não diz respeito ao portador de sofrimento psíquico? O objetivo do estudo foi conhecer o modo de admissão e a adesão dos usuários ao projeto terapêutico em um Centro de Referência em Saúde Mental (CERSAM) na cidade de Belo Horizonte – Minas Gerais. Trata-se de um estudo de caso, de abordagem qualitativa realizado em um Centro de Referência em Saúde Mental. Foram selecionados 3 técnicos de referência e 8 usuários do serviço para participar da pesquisa, mediantes critérios de inclusão e exclusão pré-estabelecidos. Foram realizadas entrevistas com roteiro semi-estruturado aos participantes, bem como, observação não-participante da dinâmica do serviço. Utilizou-se a análise de conteúdo proposta por Bardin, como técnica de análise, resultando em seis categorias e dez sub-categorias. A pesquisa foi aprovada pelo COEP da Secretaria Municipal de Saúde e da Universidade Federal de Minas Gerais. Todos os participantes assinaram o TCLE. Os participantes apontam uma articulação entre o modo de admissão e o envolvimento terapêutico, uma vez que experiências negativas no momento admissional podem ser transferidas ao serviço e ao tratamento proposto. Os usuários indicaram que a demanda espontânea configura-se o melhor modo de admissão ao serviço, em detrimento do encaminhamento por viatura policial ou serviço de urgência, devido ao despreparo...

Autonomy and crazy, historically, never walked side by side, let alone in a synchronized way. Means for autonomy, the ability of an individual to decide freely about their own actions and therefore delineate their life trajectory. Reflecting on the concepts of autonomy, crisis and demand, how the bearer of psychological distress is admitted, it expresses a demand or others? Even in crisis, it would be possible to express a demand linked to their subjectivity and social interactions. If the user does not reach the service unattended, the therapeutic project can relate to a demand that does not concern bearer of psychological distress? The aim of the study was to know the mode of admission and membership of the users in a therapeutic project Reference Center for Mental Health (CERSAM) in the city of Belo Horizonte - Minas Gerais. This is a case study, qualitative approach performed at a Center of Mental Health Reference. We selected 3 reference therapists and 8 service users to participate in the study, mediants inclusion and exclusion criteria previously established. Interviews were conducted with semi-structured participants, as well as non-participant observation of the dynamics of the service. We used content analysis proposed by Bardin, such as technical analysis, resulting in six categories and ten sub-categories. The study was approved by the COEP of the Municipal Health Department and the Federal University of Minas Gerais. All participants signed an informed consent form. Participants indicate a link between the mode of admission and therapeutic involvement, since negative experiences when admission can be transferred to the service and the proposed treatment. Users indicated that spontaneous sets up the best mode of entry into the service, instead of forwarding by police car or emergency department due to unpreparedness of these professionals in dealing with mental health. The technical reference underscore the relevance in addressing...

Fatores associados à adesão ao tratamento de crianças e adolescentes com doenças reumáticas crônicas / Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

OBJETIVO: São vários os fatores que contribuem para a má adesão ao tratamento de crianças e adolescentes com doenças reumáticas crônicas, gerando piora da qualidade de vida e do prognóstico. Nosso objetivo foi avaliar as taxas de adesão ao tratamento e identificar os fatores socioeconômicos e clínicos associados. MÉTODOS: Foram incluídos 99 pacientes com artrite idiopática juvenil, lúpus eritematoso sistêmico, dermatomiosite ou esclerodermia juvenil. Todos os pacientes eram acompanhados no ambulatório de reumatologia pediátrica por um período mínimo de 6 meses. Para avaliação da adesão, foi aplicado aos cuidadores um questionário composto por três blocos: 1) dados demográficos, clínicos e laboratoriais; 2) adesão ao tratamento medicamentoso; e 3) comparecimento às consultas, realização de exames e utilização de órteses. Foi considerada má adesão, quando realizado valor menor ou igual a 80% do prescrito. RESULTADOS: Um total de 53% dos pacientes apresentou boa adesão ao tratamento global, observada quando o cuidador possuía união estável (p = 0,006); 20 pacientes (20,2%) apresentaram má adesão ao tratamento medicamentoso, relacionada à utilização de mais que três medicamentos diários (p = 0,047). As causas de má adesão ao tratamento foram esquecimento, recusa, dose incorreta ou falta de medicamento, problemas pessoais e dificuldades financeiras. CONCLUSÕES: Observamos boa adesão ao tratamento global nos pacientes cujos cuidadores possuíam união estável e má adesão ao tratamento medicamentoso nos pacientes que utilizavam mais que três tipos de medicamentos diariamente. Não houve associação entre as taxas de adesão ao tratamento e sexo, idade, tempo de diagnóstico e atividade da doença.

OBJECTIVE: There are several factors that contribute to poor adherence to treatment in children and adolescents with chronic rheumatic diseases, worsening their quality of life and prognosis. Our aim was to assess the rates of adherence to treatment and to identify the socioeconomic and clinical factors associated. METHODS: The sample included 99 patients with juvenile idiopathic arthritis, systemic erythematosus lupus, dermatomyositis or juvenile scleroderma. All patients were followed at the outpatient pediatric rheumatology for a minimum period of 6 months. To assess adherence, a questionnaire was administered to the providers, which included three blocks: 1) demographic, clinical and laboratory data; 2) medication adherence; and 3) attending follow-up appointments, examinations and use of orthoses. A value lower than or equal to 80% of the prescribed was considered poor adherence. RESULTS: A total of 53% of patients showed good overall adherence, observed when the caregiver lived in a stable union marital status (p = 0.006); 20 patients (20.2%) presented poor medication adherence, related to the use of three or more medications daily (p = 0.047). The causes of poor adherence were forgetfulness, refusal, incorrect dose or lack of medication, personal problems, and financial difficulties. CONCLUSIONS: We observed good overall treatment adherence in patients whose providers lived in stable union and poor adherence to medication in patients who used more than three types of medication daily. There was no association between the adherence rates and sex, age, time since diagnosis and disease activity.

Efecto de medidas preventivas sobre indicadores de riesgo de caries dental

Objetivo: El propósito de este estudio fue comparar la efectividad de medidas preventivas basadas en riesgo de caries. Metodología: Una cohorte de 157 sujetos quienes asistieron a la Clínica Odontológica fue incluida en esta investigación clínica experimental durante 12 meses. El grupo test y control fueron aleatorizados para recibir prevención basada en no riesgo y riesgo. Al final de este estudio 63 individuos completaron todos estos procedimientos. La valoración del riesgo de caries se hizo a través del "Riesgograma". Resultados: El 100% de los niños tuvieron alto riesgo. Factores de riesgo de caries, tales como, presencia de placa dental, caries dental e ingesta de carbohidratos se presentaron de 95,2% a 100%. La prevención basada en riesgo fue más efectiva que la no basada en riesgo para controlar la incidencia de caries, sin embargo esta diferencia fue estadísticamente no significativa. Conclusiones: La prevención basada en riesgo puede ser un buen mecanismo para controlar la incidencia de caries, aunque es importante tener un mejor entendimiento de los indicadores de riesgo de caries y prevención basada en riesgo para planificar futuros tratamientos preventivos en países subdesarrollados.

Objective: The purpose of this study was to compare the effectiveness of preventive measures based on dental caries risk. Materials and Methods: A cohort of 157 subjects who assisted to Clínica Odontológica was enrolled in this 12 months experimental clinical investigation. Test group and control group were randomized to receive no risk-based prevention and risk based prevention. At the end of this study 63 individuals completed all of these procedures. The caries risk assessment was done through "Riesgograma". Results: The 100% of children had a high risk. Caries risk factors, such as, presence of dental plaque, dental caries and carbohydrates intake were presented from 95.2% to 100%. The risk-based prevention was more effective than no risk-based prevention to control caries incidence, however this difference was statistically insignificant. Conclusion: The risk-based prevention may be a good device to control the caries incidence, although it is relevant to have a better understanding of caries risk indicators and risk-based prevention to plan future preventive treatments in under developed countries.