Awareness of chronic obstructive pulmonary disease in current smokers: a nationwide survey

BACKGROUND/AIMS: Cigarette smoking is the most common risk factor for chronic obstructive pulmonary disease (COPD). However, few studies of the attitudes toward COPD of smokers, the group at risk of developing this condition, have been conducted. The purpose of this study was to explore the awareness of and attitudes toward COPD of current smokers. METHODS: The sample consisted of 502 individuals aged 45 and older from throughout Korea who smoked at least 10 packs of cigarettes per year. Telephone interviews using a structured questionnaire were conducted with respondents. RESULTS: First, we evaluated the health status of subjects, finding that 45.4% considered themselves to be in good health. We also asked about COPD-related symptoms, and 60.6% of subjects reported such symptoms. However, only 1.2% of subjects had been diagnosed with or treated for COPD, only 0.4% spontaneously mentioned COPD as a respiratory disease, and only 26.5% recognized COPD as a respiratory disease after seeing a list of such diseases. Television ranked as the top source of information about COPD. The willingness of 45.0% of subjects to stop smoking increased after being informed about COPD. CONCLUSIONS: Despite having COPD-related symptoms, most smokers did not know that COPD is a respiratory disease. The attitudes of smokers toward COPD and smoking cessation varied according to socioeconomic status. In summary, a continuous effort to increase the awareness of COPD among smokers is needed. Additionally, strategies tailored according to different socioeconomic groups will also be necessary.

Cumplimiento de tratamientos farmacológicos: una aproximación cualitativa a la realidad pehuenche / Pharmacological treatment compliance: a qualitative approach to the Pehuenche reality

Antecedentes: las enfermedades crónicas no transmisibles son un problema creciente en distintos grupos socioeconómicos y etarios. Dentro de las enfermedades crónicas la hipertensión arterial, la diabetes y las dislipidemias son las que presentan mayor dificultad para el control por parte del personal médico. Los principales problemas se concentran en el cumplimiento farmacológico por parte de la población mapuche y pehuenche. Metodología: se aplicó una investigación cualitativa, etnometodológica que estableció las bases teórico-metodológicas sobre las problemáticas relacionadas al concepto de enfermedad y cumplimiento farmacológico. La información se recolectó mediante entrevistas en población pehuenche. Se concluyó el proceso de reclutamiento mediante el punto de saturación de la información. Se efectuó análisis de contenido de tipo semántico estructural. Resultados: la hipertensión arterial, la diabetes y las dislipidemias, así como las enfermedades crónicas, no poseen un precedente cultural e histórico. Éstas se oponen al sistema religioso y compiten con sus instituciones. Por esta razón el tratamiento farmacológico no resulta efectivo, debido al escenario sociocultural particular. Conclusión: las diferencias conceptuales entre la medicina alopática y la cultural pehuenche redundan en problemas de cumplimiento, en especial debido a sus conceptualizaciones de las enfermedades crónicas.

Background: Chronic noncommunicable diseases are a growing problem in different socioeconomic groups and age ranges. Among chronic diseases, high blood pressure, diabetes and dyslipidemia, pose a greater monitoring challenge for medical staff, mainly treatment compliance in the Mapuche and Pehuenche people. Methodology: Qualitative, ethnomethodological investigation that provides the theoretical and methodological framework on issues related to the concept of disease and treatment compliance. Information was collected through interviews. The recruitment process was stopped when the saturation point of information was reached. At that point, structural semantic content analysis was performed. Results: Conditions such as high blood pressure, diabetes, dyslipidemia and other chronic diseases are not culturally and historically defined, contradict religious the system and compete with longstanding institutions. Consequently, drug treatment is not effective in this particular socio-cultural setting. Conclusion: The conceptual differences between allopathic and Pehuenche medicine result in compliance issues, particularly because of their conceptualizations of chronic diseases.

Análise do déficit de autocuidado de clientes hipertensos e as implicações na produção de cuidado / Analysis of self-care deficit in hypertensive clients and implications for nursing care / Análisis del déficit de autocuidado de clientes hipertensos y las implicaciones en la producción de cuidado

O objetivo desta pesquisa foi identificar o déficit de autocuidado de clientes hipertensos internados nas enfermarias de clínica médica de um hospital universitário e descrever os fatores que influenciaram esse déficit. Estudo descritivo e exploratório, desenvolvido com 15 clientes internados nas enfermarias de um hospital universitário, situado no município do Rio de Janeiro. Os dados foram coletados, em 2012, por meio de entrevista semiestruturada e submetidos à análise de conteúdo, emergindo duas categorias: reconhecendo o déficit de autocuidado e hábitos que revelam tal déficit. Conclui-se que a Teoria de Orem fornece subsídios à prática do enfermeiro para que ele seja capaz de identificar condições nas quais há um déficit na capacidade para autocuidar-se. Portanto, entende-se que a adesão ao tratamento está vinculada ao papel educativo do enfermeiro junto ao cliente.

This descriptive study aimed to identify self-care deficits in hypertensive inpatient clients on internal medicine wards of a university hospital in the municipality of Rio de Janeiro, and to describe the factors that influencedthose deficits. Data were collected in 2012 through semi-structured interviews of 15 such clients. Content analysis brought out two categories: recognizing deficits in self-care, and habits that reveal such deficits. It was concluded that Orem’s theory can inform nurses’ practices to enable them to identify conditions where there is a deficit in the capacity for self-care. Adherence to treatment is thus understood to be linked to nurses’ role in educating clients.

El objetivo de esta investigación fue identificar el déficit de autocuidado de clientes hipertensos internados en las enfermerías de clínica médica de un hospital universitario y describir los factores que influenciaron ese déficit. Estudio descriptivo y exploratorio, desarrolado con 15 clientes internados en las enfermerías de un hospital universitario de Rio de Janeiro-Brasil. Los datos fueron recolectados, en 2012, por medio de entrevista semiestructurada y sometidos al análisis de contenido, surgiendo dos categorías: reconociendo el déficit de autocuidado y hábitos que revelan ese déficit. Se concluye que la Teoria de Orem fornece subsidios a la práctica del enfermero para que ello sea capaz de identificar condiciones en las cuales hay un déficit en la capacidad para autocuidarse. Por lo tanto, se entiende que la adhesión al tratamiento está vinculada al rol educativo del enfermero junto al cliente.

Adherence to medications in a group of Bahraini and Egyptian patients with bipolar mood disorder

The aim of this study was to identify predictors of non-adherence to medications in a group of bipolar mood disorder patients as well as the trans-cultural differences in non-adherence among them. Participants were 51 Bahraini and 53 Egyptians patients with bipolar mood disorder who had been prescribed medications within the past 12 months. Treatment adherence was evaluated by self-report of these patients. There was a distinction between intentional non-adherence [e.g., alteration of medication regimen to fit one's needs] and unintentional non-adherence than developing manic episodes for getfuiness]. No cultural group differences in intentional non-adherence were suggested. Egyptian patients reported significantly more unintentional non-adherence than Bahraini patients. however, once other predictors were entered into the model, cultural difference did not remain a significant predictor. After controlling for cultural factor and medication type, intentional non-adherence was associated with perceiving medication as less important, concerns about the side effects of medications and the stigma associated with medications. Unintentional non-adherence was associated with co-morbidity of drug abuse and development of manic episodes. results suggest no cultural difference in terms of barriers to adherence to medications. Interventions to increase adherence the bipolar patients. Drug education and information about the illness and its co-morbidity with drug abuse might help the patients and families

Um estudo de caso sobre a experiência da doença de diabéticos tipo 2 usuários de uma unidade básica de saúde da família de Araguari-MG / A case study on experience of illness of diabetes type 2 in a Basic Unity of Family Health in Araguari, Minas Gerais

A transição nutricional causou transformações no perfil de adoecimento da população, sendo o diabetes mellitus tipo 2 uma das principais patologias. A atenção primária à saúde é fundamental na implantação de políticas públicas para controle do diabetes, de forma a administrar os fatores de risco e a oferecer conhecimentos que favoreçam a adesão aos tratamentos medicamentoso e nutricional. No caso da adesão ao tratamento, ressalta-se a forte influência das redes de convívio social que norteiam a experiência da doença pelo sujeito. Este estudo visa analisar a experiência da doença dos portadores de diabetes mellitus tipo 2, acompanhados em domicílio por agentes comunitários de uma Unidade Básica de Saúde da Família de Araguari, Minas Gerais. Trata-se de pesquisa qualitativa ligada ao Programa de Pós-Graduação em Saúde Pública do Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz. A metodologia utilizada está baseada em uma tentativa de exercício etnográfico, cujos sujeitos foram entrevistados em seus domicílios pela pesquisadora responsável. Os resultados mostram que a experiência da doença inicia-se com a descoberta do diabetes relacionada a sintomas de polidipsia e poliúria, percebidos pelos próprios sujeitos e diagnosticados na unidade de saúde. O primeiro tratamento buscado é a assistência médica do serviço de saúde, sendo as práticas integrativas utilizadas somente pelos diabéticos considerados descompensados. A descompensação surge pelo desequilíbrio social do meio em que o doente vive. Este estudo pode contribuir para a melhor adesão ao tratamento oficial do diabetes, a partir da valoração da cultura dos doentes pelo serviço de saúde oficial, de modo a desconstruir o discurso biomédico na rede municipal de saúde em questão.

Gender and ethnicity in first admissions to a psychiatric unit in Trinidad

It has been recognized that there are gender disparities in the admission rates to psychiatric units. While the community prevalence of the major non-organic psychotic mental disorders are thought to have no gender bias, non-psychotic disorders such as depression are more commonly diagnosed in women. Gender differences in admission may indicate differences in severity or in presentation to psychiatric services and would have important implications for the targeting of preventative strategies. The case notes of all admissions to the psychiatric unit at the San Fernando General Hospital were obtained for the calendar year 1999. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses and gender were analysed to determine the distribution of diagnostic categories by gender. A total of 119 patients were admitted to the unit for the first time in the period under review, 72 were male (60.5) and 47 were female (39.5). There were no significant differences in age by gender. Substance use related admissions and psychotic illnesses (schizophrenia spectrum and affective psychoses) were significantly more common in men (p = 0.006; p = 0.03 respectively). These differences were especially marked for those of East Indian descent. Non-psychotic illnesses were more commonly diagnosed among women (p = 0.0008). These findings suggest that a larger proportion of males are admitted to the general hospital psychiatric unit among first time admissions. This is also true for re-admissions. Men are more likely to be diagnosed with substance use and psychotic disorders, while for women, major depression and non-psychotic illnesses are the main diagnoses. Community surveys are needed to determine whether this demographic pattern of admission reflects the population prevalence of these disorders. Reduction of admission rates will require interventions that are sensitive to gender differences in diagnosis among those admitted to psychiatric units

Factores asociados con el incumplimiento del tratamiento antipalúdico en pacientes ecuatorianos / The factors associated with noncompliance with antimalarial treatment in Ecuadorian patients

A total of 249 persons living in the northwest part of Ecuador with a clinical diagnosis of malaria confirmed by thick blood films were treated with chloroquine and primaquine according to the therapeutical system in force in the National Service for Eradication of Malaria. New clinical assessment and thick blood film were applied after 4 days in P. falciparum (n = 120) cases and after 8 days in P. vivax (n = 129) cases; patients were questioned about the compliance or non-compliance with the treatment, and the reasons for their acting in either way were studied. EPI-INFO 6.04 and SPSS PC 7.0 packages served to process the information: "kind adjustment test" (bondad de ajuste) abd factorial analysis of correspondences were used. The patient who daily took his/her pills for the number of days indicated, at the established intervals and at the right time was defined as a patient complying with the drug therapy. For every 3 patients complying with treatment, there were 2 who did not; non-compliance was not significantly related to age, sex, educational level, ethnic group, urban or rural setting or level of income, but learning about seriousness of the infection did help to compliance with the therapy. The reasons for non-compliance were mainly associated with drugs (side effects/reluctancy to take drugs), with the fact of forgetting to take them and of "getting cured quickly". The profile of the patient who did not comply with treatment corresponded to male, teenager, mixed race, poor and rural setting.