ABSTRACT
Introducción: La adherencia al tratamiento es un problema de salud pública, con importancia en las terapias de enfermedades crónicas. La adherencia deficiente a tratamientos a largo plazo compromete la efectividad del tratamiento e influye directamente en la calidad de vida. Objetivo: Establecer la relación que existe entre adherencia al tratamiento y la calidad de vida de pacientes adultos hipertensos en dos hospitales de segundo nivel. Métodos: Estudio descriptivo transversal, con análisis de asociación, muestreo no probabilístico a conveniencia, se seleccionó muestra utilizando programa Open Epi en línea, resultando 206 pacientes que cumplieron criterios de inclusión. La adherencia se midió con test de Morisky- Green-Levine y la calidad de vida con MINICHAL. Los datos fueron analizados en SPSS Statistic 21.0; análisis univariado, calculando frecuencias, porcentajes y el bivariado (asociación entre adherencia/factores de adherencia y calidad de vida), se aplicó prueba del chi cuadrado y modelo de regresión logística binaria. Contó con aprobación ética. Resultados: La población estudiada fue de predominio femenino, entre 51-60 años, alfabeta, casados, pobres. El 71.4% (147) eran adherentes al tratamiento. La calidad de vida fue media-alta en 80.1% (165). Se presentó asociación entre la variable adherencia y escolaridad (p<0.01), nivel de pobreza (p<0.01), uso de otros fármacos (p<0.01). No se encontró asociación entre adherencia y calidad de vida. (p <0.1) Discusión: La adherencia al tratamiento fue alta. Los adherentes al tratamiento tenían calidad de vida media-alta, los no adherentes calidad de vida baja; los pacientes con polifarmacia, mayor escolaridad y nivel socioeconómico tienen mejor adherencia al tratamiento...(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Antihypertensive Agents/therapeutic use , Pharmaceutical Preparations , Public Health , Treatment Adherence and ComplianceABSTRACT
Introducción: Los objetivos del control del asma son prevenir la aparición de síntomas y reducir el riesgo de exacerbaciones y mortalidad mediante educación médica, técnica inhalatoria, adherencia a medicación controladora e indicación de planes de acción (PA); pero los pacientes enfrentan exacerbaciones de diversa gravedad. Objetivos: El objetivo principal del estudio SABINA EMERGENCIAS fue describir la forma en que los pacientes concurren al servicio de emergencias (SE), considerando la frecuencia y uso de medicación de rescate. Objetivos secundarios: consultas al SE; uso de corticoides sistémicos (CS), agonistas beta-2 de acción corta (SABA) y tratamiento controlador; disponibilidad de PA. Material y Métodos: Estudio transversal, observacional, descriptivo, en cuatro hospitales del área metropolitana de Buenos Aires en adultos con asma. Resultados: n=323 (edad: 43,7±16,8 años; mujeres: 66,6%): 61,3% no eran seguidos por especialistas; 90,1% utilizaron SABA como rescate (mediana:10 inhalaciones; rango 0-100) la semana previa; 75,9% tuvieron ≥1 consulta al SE el año previo (mediana:2 [0-100]); 29,4% habían sido hospitalizados; 59,1% recibieron ≥1 ciclo de CS; mediana de consumo de SABA: 3 envases/año (0-23); 51,7% habían utilizado ≥3 envases; 30% no empleaban tratamiento de mantenimiento (23% usaba SABA); 75,9% no efectuaban terapia regular de mantenimiento; 77,1% no contaban con PA. Conclusión: Una reducida proporción de pacientes asmáticos que concurren al SE son seguidos por médicos especialistas, con alto consumo y elevada frecuencia de aplicación de SABA como rescate y baja adherencia al tratamiento de mantenimiento. Se remarca la necesidad de optimizar el manejo, con énfasis en la derivación al especialista, adherencia al tratamiento y prescripción de PA.
Introduction: The objectives of asthma control are to prevent the onset of symptoms and reduce the risk of exacerbations and mortality through medical education, inhaler technique, adherence to controller medication and indication of action plans (AP); but patients experience exacerbations of varying severity. Objective: The main objective of the SABINA EMERGENCIAS study was to describe how patients attend the emergency department (ED), considering the frequency and use of rescue medication. Secondary objectives: ED visits; use of systemic corticosteroids (SC), short-acting beta-2 agonists (SABA) and controller therapy; availability of AP. Methods: Cross-sectional, observational, descriptive study in 4 hospitals in the metropolitan area of Buenos Aires in adults with asthma. Results: n=323 (age:43.7±16.8 years; women:66.6%): 61.3% were not followed by specialists; 90.1% used SABA as rescue medication (median:10 puffs; range 0-100) the previous week; 75.9% had ≥1 visit to the ES the previous year (median: 2 [0-100]); 29.4% had been hospitalized; 59.1% received ≥1 cycle of CS; median SABA consumption: 3 cannisters/year (0-23); 51.7% had used ≥3 cannisters; 30% did not use maintenance therapy (23% used SABA); 75.9% did not perform regular maintenance therapy; 77.1% did not have an AP. Conclusion: A small proportion of asthmatic patients attending the ES are followed by specialist physicians, with high consumption and high frequency of SABA application as rescue medication and low adherence to maintenance treatment. The need to optimize management is highlighted, with emphasis on referral to specialists, adherence to treatment and prescription of APs.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Asthma/diagnosis , Emergency Service, Hospital , Symptom Flare Up , Argentina , Quality of Life , Bronchodilator Agents , Surveys and Questionnaires , Adrenal Cortex Hormones , Dyspnea , Education, Medical , Treatment Adherence and ComplianceABSTRACT
Objective. To determine the predictive role of resilience and hope on adherence to treatment in hemodialysis patients hospitalized in two hospitals affiliated to Shiraz University of Medical Sciences (Shiraz, Iran). Methods. This is a descriptive-analytical study that was conducted in 2021-2022 on 120 patients treated in hemodialysis sections in Namazi and Shahid Faqihi teaching hospitals. Sampling was conducted using a stratified random method. Demographic information questionnaires, Connor and Davidson's resilience, Snyder's hope and adherence to kidney patients' treatment questionnaires were used to collect the data. Results. The finds showed that the levels of resilience, hope, and adherence to treatment had hight level. More specifically, it was indicated that the mean and standard deviation for the total resilience score, the hope variable, and adherence to total treatment was 75.45±14.34, 40.43±3.66, and 80.12±18.20, respectively; which have maximum possible scores of 100, 48 and 100. Thus, it can be said that no correlation was observed between resilience and adherence to treatment variables (p>0.05); hope variable and adherence to treatment (p>0.05), and adherence to treatment with hope and resilience variables (p>0.05). However, hope and resilience variables showed a direct and weak correlation with each other (r=0.36, p<0.05); that is, patients who had more hope indicated better resilience as well. Conclusion. Although in this study we found that the resilience and hope variables were not able to predict the treatment adherence, hope and resilience indicated a direct and weak correlation. It is recommended that nurses should pay more attention to hope and resilience of hemodialysis patients in order to promote their health.
Objetivo. Determinar el papel predictivo de la resiliencia y la esperanza en la adherencia al tratamiento en pacientes en hemodiálisis internados en dos hospitales afiliados a la Universidad de Ciencias Médicas de Shiraz (Shiraz, Irán). Métodos. Se trata de un estudio descriptivo-analítico que se realizó en 2021-2022 con la participación de 120 pacientes tratados en secciones de hemodiálisis en los hospitales docentes Namazi y Shahid Faqihi. El muestreo se realizó mediante un método aleatorio estratificado. Para la recogida de datos se utilizaron datos demográficos y las escalas de resiliencia de Connor y Davidson, de esperanza de Snyder y de adherencia al tratamiento de pacientes renales. Resultados. Los hallazgos mostraron que los niveles de resiliencia, esperanza y adherencia al tratamiento se encontraban en niveles altos. Más concretamente, se indicó que la media y la desviación estándar para la puntuación total de resiliencia, la variable esperanza y la adherencia al tratamiento total fueron 75.45±14.34, 40,43±3.66 y 80.12±18.20, respectivamente; las cuales tienen como puntajes máximos posibles 100, 48 y 100. No se observó correlación entre las variables: resiliencia y adherencia al tratamiento (p>0.05), esperanza y la adherencia al tratamiento (p>0.05), y adherencia al tratamiento y las variables esperanza y resiliencia (p>0.05). Sin embargo, las variables esperanza y resiliencia mostraron una correlación directa y débil entre sí (r=0.36, p<0.05); es decir, los pacientes que tenían más esperanza indicaron también mejor resiliencia. Conclusión. Aunque en este estudio encontramos que las variables resiliencia y esperanza no fueron capaces de predecir la adherencia al tratamiento, la esperanza y la resiliencia indicaron una correlación directa y débil. Se recomienda que el personal de enfermería preste más atención a la esperanza y la resiliencia de los pacientes en hemodiálisis para promover su salud.
Objetivo. Determinar o papel preditivo da resiliência e da esperança na adesão ao tratamento em pacientes em hemodiálise internados em dois hospitais afiliados à Universidade de Ciências Médicas de Shiraz (Shiraz, Irã). Métodos. Trata-se de um estudo descritivo-analítico realizado em 2021-2022 com a participação de 120 pacientes atendidos nas seções de hemodiálise dos hospitais universitários Namazi e Shahid Faqihi. A amostragem foi realizada por método aleatório estratificado. Para a coleta de dados foram utilizados dados demográficos e as escalas de resiliência de Connor e Davidson, escalas de esperança de Snyder e adesão ao tratamento de pacientes renais. Resultados As descobertas mostraram que os níveis de resiliência, esperança e adesão ao tratamento estavam em níveis elevados. Mais especificamente, foi indicado que a média e o desvio padrão do escore de resiliência total, da variável esperança e da adesão total ao tratamento foram 75.45±14.34, 40.43±3.66 e 80.12±18.20, respectivamente; que possuem as pontuações máximas possíveis de 100, 48 e 100. Não foi observada correlação entre as variáveis: resiliência e adesão ao tratamento (p>0.05), esperança e adesão ao tratamento (p>0.05), e adesão ao tratamento e esperança e variáveis de resiliência (p>0.05). Contudo, as variáveis esperança e resiliência apresentaram correlação direta e fraca entre si (r=0.36, p<0.05); Ou seja, os pacientes mais esperançosos também indicaram melhor resiliência. Conclusão. Embora neste estudo tenhamos constatado que as variáveis resiliência e esperança não foram capazes de predizer a adesão ao tratamento, a esperança e a resiliência indicaram uma correlação direta e fraca. Recomenda-se que a equipe de enfermagem preste mais atenção à esperança e à resiliência dos pacientes em hemodiálise para promover sua saúde.
Subject(s)
Humans , Male , Female , Renal Insufficiency, Chronic , Resilience, Psychological , Hope , Treatment Adherence and Compliance , Hemodialysis Units, HospitalABSTRACT
The aim of this study was to evaluate the effectiveness of motivational interviewing on improving oral hygiene behavior in patients with fixed orthodontics appliances. A parallel-group randomized clinical trial was conducted with 45 patients of the Orthodontic Clinic of Unibe's Postgraduate Unit. A computer-generated list of numbers created with SPSS V21.0 was used to randomly allocate participants into the experimental or the control group. Monthly oral hygiene instructions and an oral hygiene kit from GUM® with special orthodontic hygiene tools were given to the participants. Furthermore, the experimental group underwent motivational interviewing sessions facilitated by a periodontist who received training from two expert psychologists. These psychologists also provided supervision to the interviewer, ensuring the accurate implementation of the intervention. Simplified Oral Hygiene Index (SOHI), Gingival Index (GI), Periodontal Probing Depth (PPD) and Bleeding on Probing (BoP) were recorded at baseline, three and six months after the beginning of the study. The participant and the evaluator (another periodontist who recorded the data) were masked. Repeated-measures mixed- model analysis of variance and chi-squared test were conducted. Mean SOHI, GI, PPD and BoP scores did not differ significantly across the three time points (baseline, three and six months). Nevertheless, a significant interaction on SOHI scores (F (2, 58) = 3.463, p = .038, h2 = .052) was found between the sessions and the treatment conditions (experimental vs control group) at the third and sixth month. Motivational interviewing plus oral hygiene instructions appears to maintain a better control of dental biofilm and calculus in comparison with conventional oral hygiene instructions alone.
El objetivo de este trabajo fue evaluar la efectividad de las entrevistas motivacionales para mejorar el comportamiento de higiene oral en pacientes con aparatos ortodóncicos fijos. Se llevó a cabo un ensayo clínico aleatorizado de grupos paralelos con 45 pacientes de la Clínica de Ortodoncia de la Unidad de Posgrado de Unibe. Se utilizó una lista de números generada por computadora con SPSS V21.0 para asignar aleatoriamente a los participantes al grupo experimental o de control. Se les proporcionó a los participantes instrucciones mensuales de higiene oral y un kit de higiene oral de GUM® con utensilios de higiene especiales para ortodoncia. Además, el grupo experimental recibió sesiones de entrevista motivacional facilitadas por un periodoncista capacitado por dos psicólogas expertas. Estas psicólogas también supervisaron al entrevistador, asegurando la implementación precisa de la intervención. Se registró el Índice Simplificado de Higiene Oral (IHO-S), el Índice Gingival (IG), la Profundidad de Sondaje Periodontal (PS) y el Sangrado al Sondaje (SS) al inicio, a los tres y seis meses después del inicio del estudio. Tanto el participante como el evaluador (otro periodoncista que registró los datos) estaban enmascarados. Se realizaron análisis de varianza de medidas repetidas con modelo mixto y pruebas de chi-cuadrado. Las puntuaciones medias del IHO-S, IG, PS y SS no difirieron significativamente en los tres momentos (inicio, tres y seis meses). Sin embargo, se encontró una interacción significativa en las puntuaciones del IHO-S (F (2, 58) = 3.463, p = .038, h2 = .052) entre las sesiones y las condiciones de tratamiento (grupo experimental vs grupo de control) en el tercer y sexto mes. Las entrevistas motivacionales junto con las instrucciones de higiene oral parecen mantener un mejor control de la biopelícula dental y el cálculo en comparación con las instrucciones convencionales de higiene oral por sí solas.
Subject(s)
Humans , Orthodontics/methods , Orthodontic Appliances, Fixed , Oral Hygiene , Periodontal Index , Motivational Interviewing , Treatment Adherence and Compliance , Duration of Therapy , Transtheoretical Model , Sociodemographic FactorsABSTRACT
El 25% de los pacientes con Enfermedades Inflamatorias Intestinales (EII) se diagnostican antes de los 20 años. En la mayor parte de los centros del país se lleva a cabo la "transferencia" del paciente desde un centro de atención pediátrico a uno de adultos. La "transición" es un criterio de calidad con beneficios en el control de la EII reduciendo el número de recaídas, de hospitalizaciones y de cirugías. Por tal motivo hemos desarrollado un Programa Interdisciplinario de Transición entre dos hospitales de referencia nacional e internacional en EII. Materiales y métodos: Entre 1/2021 y 12/ 2022 se incorporaron 24 pacientes que ingresaron en 3 fases: Fase 1 Pacientes entre 14 y 16 años asistidos en el Hospital Garrahan (HG) con un abordaje interdisciplinario. Fase 2. A partir de los 17 años se realizaron 2 (dos) encuentros en el HG en conjunto con gastroenterólogos de adultos evaluando adherencia y autonomía y la Fase 3 llevada a cabo en el Hospital B. Udaondo (HBU) sólo con el equipo de adultos luego de 6 meses de realizada la transferencia evaluando adherencia al tratamiento, consultas a emergencias, internación y/o cirugías Resultados: Al inicio del Programa el 66% de los pacientes presentaban una actividad moderada a severa vs el 8% al finalizar la fase 3. Luego de la transferencia el 12,5% necesito ingreso a guardia e internación y un 8% tratamiento quirúrgico. El 83% de los pacientes continúan en seguimiento luego de 6 meses de haber sido transferidos (AU)
Twenty-five percent of patients with inflammatory bowel diseases (IBD) are diagnosed before the age of 20 years. In most centers in the country, the "transfer" of the patient from a pediatric to an adult care center is done. However, "transition" is a quality criterion with benefits in the control of IBD by reducing the number of relapses, hospitalizations, and surgeries. For this reason, we developed an Interdisciplinary Transition Program between two national and international reference hospitals in IBD. Materials and Methods: Between January 2021 and December 2022, we incorporated 24 patients into a three-phase program. Phase 1 involved patients between 14 and 16 years of age seen at Garrahan Hospital (HG) with an interdisciplinary approach. Phase 2 began from 17 years of age, with two meetings held at HG involving adult gastroenterologists to evaluate adherence and autonomy. Phase 3 was conducted at Hospital B. Udaondo (HBU) only with the adult team, six months after the transfer, evaluating adherence to treatment, emergency consultations, hospitalizations, and/or surgeries. Results: At the beginning of the program, 66% of the patients presented with moderate to severe disease activity, compared to 8% at the end of Phase 3. After the transfer, 12.5% of the patients required emergency department visits and hospitalization, and 8% required surgical treatment. Eighty-three percent of the patients continue in the program and are still being followed up six months after the transfer (AU)
Subject(s)
Humans , Adolescent , Inflammatory Bowel Diseases/therapy , Adolescent , Transition to Adult Care/organization & administration , Treatment Adherence and Compliance , Patient Care Team , Chronic Disease , Surveys and QuestionnairesABSTRACT
Cada vez más pacientes trasplantados hepáticos durante la edad pediátrica alcanzan la adultez debido al aumento en las tasas de sobrevida a largo plazo, por lo que requieren continuar su atención en un centro de adultos. Este pasaje entre centros se asocia con peores resultados clínicos y mayor mala adherencia, debido al momento de vulnerabilidad que representa este momento en la atención médica y por el mismo momento vital atravesado por el paciente adolescente. La mayoría de los centros de trasplantes establecieron programas de transición para mejorar estos resultados. Para que estos programas sean efectivos, deben conocerse las barreras y los facilitadores de adherencia tanto en el paciente como en su entorno. El objetivo de este trabajo es reconocer estos factores de riesgo y su relación con mala adherencia y resultados clínicos, y realizar un seguimiento a corto plazo de los pacientes transferidos a un centro de atención de adultos. Para esto, se realizó una encuesta pre y post derivación a una cohorte de pacientes adolescentes del Hospital Garrahan. Para medir mala adherencia se utilizaron métodos objetivos y subjetivos, cada uno de los cuales correlacionó con distintos factores de riesgo, como presencia de violencia, consumo de sustancias y déficit educativo. Como conclusión, medir la mala adherencia es complejo debido a que su origen es multifactorial. Al parecer, combinar cuestionarios validados con entrevistas no estructuradas es la estrategia más efectiva para detectar mala adherencia en la consulta médica. Luego, las variables psicosociales están cobrando cada vez más relevancia y deben ser consideradas en los programas de transición de los servicios de trasplante si se quiere lograr un seguimiento a largo plazo exitoso (AU)
An increasing number of pediatric liver transplant patients reach adulthood due to the increase in long-term survival rates, and therefore require continued care in an adult center. This transition between centers is associated with worse clinical outcomes and poorer adherence, due to the vulnerability that this moment in medical care represents and the same vital moment that the adolescent patient goes through. Most transplant centers have established Transition Programs to improve these outcomes. For these programs to be effective, the barriers and facilitators of adherence in both the patient and their environment should be known. The aim of this study was to identify these risk factors and their relationship with poor adherence and clinical outcomes, and to perform a short-term follow-up of patients transferred to an adult care center. For this purpose, a pre- and post-referral survey was conducted on a cohort of adolescent patients from the Garrahan Hospital. Objective and subjective methods were used to measure poor adherence, each of which correlated with different risk factors, such as the presence of violence, substance use, and educational deficits. In conclusion, measuring poor adherence is complex because its origin is multifactorial. Combining validated questionnaires with unstructured interviews seems to be the most effective strategy for detecting poor adherence in the medical consultation. Therefore, psychosocial variables are becoming increasingly relevant and should be considered in the Transition Programs of transplantation services if a successful longterm follow-up is to be achieved (AU)
Subject(s)
Humans , Adolescent , Surveys and Questionnaires , Risk Factors , Follow-Up Studies , Liver Transplantation , Transition to Adult Care/organization & administration , Treatment Adherence and Compliance , Chronic Disease , Prospective Studies , Cohort StudiesABSTRACT
Los sobrevivientes de un trasplante alogénico de células progenitoras hematopoyéticas (TACPH) pediátrico presentan alto riesgo de padecer problemas de salud. Debido a esta vulnerabilidad, la continuidad del cuidado impacta en su pronóstico y la transición a la medicina del adulto (TMA) es un proceso clave. Objetivo: Evaluar el proceso actual de TMA de los receptores de TACPH en nuestro hospital. Métodos: Diseño: observacional retrospectivo y prospectivo. Población: todos los pacientes (p) que realizaron su TMA desde enero/2022 a marzo/2023. Instrumentos: entrevista personal; material escrito; resumen de historia clínica; escalas TRAQ 5.0 (transición), PedsQL 4.0 (CVRS) y Lansky (funcionalidad); elección de estrategias de seguimiento según complejidad y requerimientos; contacto con profesionales de adultos; entrevista telefónica luego de 6 meses posTMA; red conformada. Resultados: 36p completaron la TAM (33 presencial, 3 virtual). Edad m19 años (m6 años de seguimiento), 70% del interior del país, 58% TACPH por enfermedad maligna, 64% TACPH familiar. A la TMA: antecedente EICHc 50%, segunda enfermedad maligna 2%, compromiso órganos 75% (m2/p, r0-8, mayormente endocrinológicas, oculares y neurológicas), 94% Lansky ≥80 (r50-100), PedsQL m82 (27% ≤75), TRAQ m3.4 (r1.7- 4.8). Derivación: todos los p cubrían sus necesidades (30% en centros de alta complejidad o expertos en THA) pero 3p debieron readecuar las estrategias, 5p presentaban complicaciones en actividad o necesidad de pronta resolución. Contacto posterior: 30/33p continuaban seguimiento, 3p pudieron retomarlo, 9p nuevas complicaciones/tratamientos. Red: 20 profesionales/instituciones. Conclusiones: Se refuerza la necesidad y utilidad de un proceso de TMA tanto formal como personalizado según necesidades individuales de los pacientes con TACPH (AU)
Pediatric allogeneic hematopoietic stem cell transplant (HSCT) survivors are at high risk for health problems. Because of this vulnerability, continuity of care impacts their prognosis and transition to adult medicine (TAM) is a key process. Objective: To evaluate the current process of TAM of HSCT recipients in our hospital. Methods: A retrospective and prospective observational study was conducted. The population included all patients (p) who underwent TAM from January 2022 to March 2023. Instruments used included personal interviews, written materials, medical history summaries, the TRAQ 5.0 (transition), PedsQL 4.0 (HRQoL), and Lansky (functionality) scales. Follow-up strategies were chosen according to complexity and requirements, with contact established with adult professionals and a telephone interview conducted six months post-TAM in an established network network. Results: 36p completed TAM (33 face-to-face, 3 online). Mean age was 19 years (with a mean of 6 years of follow-up); 70% were from the provinces of the country, 58% underwent HSCT due to malignant disease, 64% had familial HSCT. At TAM: 50% had a history of GVHD, 2% had a second malignant disease, and 75% had organ involvement (mean of 2 per patient, ranging from 0 to 8, mostly endocrinological, ocular, and neurological), 94% had Lansky ≥80 (range, 50-100), mean PedsQL was 82 (27% ≤75), mean TRAQ was 3.4 (range, 1.7-4.8). Referral needs were met for all patients (30% in tertiary-level centers or with experts in allogeneic HSCT), although 3 patients had to readjust strategies, and 5 had complications requiring prompt resolution. In subsequent contact, 30 out of 33 patients continued follow-up, 3 resumed it, and 9 experienced new complications or treatments. The network included 20 healthcare providers/institutions. Conclusions: This study reinforces the need for and usefulness of a formal and personalized TAM process according to the individual needs of patients with HSCT (AU)
Subject(s)
Humans , Adolescent , Quality of Life , Survival , Transplantation, Homologous , Risk Factors , Hematopoietic Stem Cell Transplantation , Transition to Adult Care/organization & administration , Chronic Disease , Prospective Studies , Retrospective Studies , Interview , Treatment Adherence and ComplianceABSTRACT
Introducción: Las mujeres con predisposición genética-familiar presentan un riesgo más elevado de desarrollar cáncer de mama. La vigilancia es una de las estrategias más efectivas para ofrecer a este subgrupo de mujeres, sin embargo la adherencia a la misma puede ser dificultosa. Objetivo: Analizar la adherencia de las pacientes con Alto Riesgo Heredo-Familiar (ARHF) al programa específico de "Seguimiento de pacientes de Alto Riesgo" del Hospital Universitario Austral. Material y método: Se revisaron de forma retrospectiva datos de 104 mujeres sanas con ARHF que ingresaron al programa de vigilancia: "Seguimiento de pacientes de Alto Riesgo" del Hospital Universitario Austral en el período comprendido entre junio de 2016 a febrero de 2022. Resultados: La adherencia al programa fue total en 38 pacientes (36,54%) y parcial en 42 (40,38%). Se observó falta de adherencia en 24 pacientes (23,07%). La causa más prevalente fue la incomodidad al realizar la resonancia (54,16%). Analizando la adherencia según el año de ingreso al programa se observa una caída significativa a partir del 3er año de seguimiento y solo 48,98% completaron la sexta ronda. Conclusiones: La falta de adherencia observada fue significativa. Los datos demostrados apuntan a una necesidad de continuar desarrollando estrategias que faciliten el seguimiento(AU)
Introduction: Women with a genetic-familial predisposition have a higher risk of developing breast cancer. Surveillance is one of the most effective strategies to offer this subgroup of women, however adherence to it can be difficult. Objetive: To analize the adherence of patients with High Risk of Familial-Hereditary (HRFH) breast cancer to a specific program: "Follow-up in High Risk patients" of the Austral University Hospital. Material and method: Data from 104 women with HRFH who were admitted to the surveillance program: "Follow-up in High Risk patients" of the Austral University Hospital in the period from june 2016 to february 2022 were retrospectively reviewed. Results: Adherence to the program was complete in 38 patients (36,54%) and partial in 42 (40,38%). 24 (23,07%) patients had lack of adherence. The most prevalent cause was discomfort when performing the resonance (54,16%). When we analyze adherence according to the year of admission to the program, a significant drop is observed from de 3rd year of follow-up and only 48,98% completed round six. Conclusions: The observed lack of adherence was significant. The demonstrated data points to a need to continue developing strategies that facilitate monitoring(AU)
Subject(s)
Treatment Adherence and Compliance , Genetic Diseases, InbornABSTRACT
Con el advenimiento de nuevas técnicas quirúrgicas y medicaciones inmunosupresoras la sobrevida de los niños trasplantados mejoró, llegando a la adultez. La continuidad de su tratamiento requiere un proceso planificado que permita su tránsito a un sistema de salud orientado al adulto. El objeto de este trabajo es mostrar la transición a centros de adultos en una cohorte de pacientes trasplantados renales en el Hospital Garrahan, describir sus características clínicas y demográficas, su evolución, y oportunidades de mejora implementadas. Debido a cambios médicos y su abordaje desde la interdisciplina, se dividió a la población en tres periodos: era 1 (1988-1999), era 2 (2000-2009), y era 3 (2010- 2023). En la era 1, 179 adolescentes continuaron su atención médica en un centro de adultos, 212 en la era 2 y 201 en la era 3. En la era 1 el seguimiento estaba coordinado por el nefrólogo de cabecera y eran consultados los servicios de Urología, Servicio Social y Salud Mental. En la era 2, se fortaleció el trabajo en interdisciplina y aún más a partir del 2011. Surgieron centros de trasplante de adultos que recibían adolescentes y médicos dedicados a ellos en forma preferencial. En la actualidad la transición comienza a los 12 años y progresa hasta los 18. El modelo implementado es la transición directa, entre el nefrólogo pediatra y el de adultos, con varias consultas secuenciales en ambos centros. Si bien la sobrevida del paciente e injerto mejoraron, el rechazo, asociado a no adherencia, es una asignatura por mejorar (AU)
With the advent of new surgical techniques and immunosuppressive medications, the survival of transplanted children has improved, allowing them to reach adulthood. The continuity of their treatment requires a planned process that facilitates their transition to an adult-oriented healthcare system. The aim of this study was to examine the transition to adult centers in a cohort of renal transplant patients at Garrahan Hospital, describing their clinical and demographic characteristics, their evolution, and the improvement opportunities implemented. Based on medical changes and the interdisciplinary approach, the population was divided into three periods: era 1 (1988- 1999), era 2 (2000-2009), and era 3 (2010-2023). In era 1, 179 adolescents continued their medical care in an adult center, 212 in era 2, and 201 in era 3. In era 1, follow-up was coordinated by the attending nephrologist with consultations from Urology, Social Services, and Mental Health Services. In era 2, interdisciplinary work was strengthened, and even more so since 2011. Adult transplant centers were created to receive adolescents with physicians dedicated to their care on a preferential basis. Currently, the transition begins at 12 years of age and progresses up to 18. The implemented model involves direct transition between the pediatric nephrologist and the adult nephrologist, with several sequential consultations in both centers. Although patient and graft survival have improved, rejection associated with non-adherence remains an area for improvement
Subject(s)
Humans , Child , Adolescent , Patient Care Team , Kidney Transplantation , Treatment Outcome , Transition to Adult Care/organization & administration , Transitional Care , Treatment Adherence and Compliance/psychology , Graft Rejection/prevention & control , Graft Survival , Retrospective Studies , Observational StudyABSTRACT
Serious games emerge as teaching tools with a purpose beyond entertainment, aiming to improve some aspect of the teaching-learning process. Given the high prevalence of chronic noncommunicable diseases in the Brazilian population, this study aimed to evaluate, through a systematic literature review, the potential of serious games as a tool for Food and Nutrition Education. To this end, we searched the PubMed, Biblioteca Virtual de Saúde, and SciELO databases for articles published in the last five years in english and portuguese. A total of 63 studies were identified, of which only 10 met the inclusion and exclusion criteria established for this review. Most studies reported positive outcomes with the use of serious games as an educational tool, finding positive effects on the retention of knowledge learned about food and nutrition, and their use showed promise as an alternative to traditional teaching methodologies. Despite this, the studies had limitations regarding the duration of the interventions and the representativeness of their sample sizes, indicating the need for future studies with methodological designs that fill such gaps. This review shows that gamified approaches to nutrition education seem promising in the context of the teaching-learning process but still lack methodological standardization for interventions based on serious games to be validated as a tool for Food and Nutrition Education.
Os serious games despontam como ferramentas de ensino que são jogos com um propósito para além do entretenimento, tendo como objetivo a melhoraria de algum aspecto do processo de ensino-aprendizagem. Frente a alta prevalência de doenças crônicas não transmissíveis na população brasileira, o objetivo do presente estudo foi avaliar, por meio de uma revisão sistemática da literatura, o potencial dos serious games como instrumento de Educação Alimentar e Nutricional. Para tanto, buscou-se nas bases de dados PubMed, Biblioteca Virtual de Saúde e SciELO, artigos publicados nos últimos cinco anos, nos idiomas inglês e português. Um total de 63 estudos foram identificados, dos quais apenas dez atenderam aos critérios de inclusão e exclusão estabelecidos para esta revisão. A maioria dos estudos reportaram desfechos positivos com a utilização dos serious games como ferramenta educativa, encontrando efeitos positivos na retenção dos conhecimentos aprendidos sobre alimentação e nutrição, e a sua utilização se mostrou promissora como uma alternativa às metodologias de ensino tradicionais. Apesar disso, os estudos apresentaram limitações quanto a duração das intervenções e a representatividade do tamanho de suas amostras, indicando a necessidade de futuros estudos com delineamento metodológico que supram tais lacunas. A partir desta revisão, demonstra-se que abordagens gamificadas de educação nutricional parecem promissoras no contexto do processo de ensino-aprendizagem, mas que ainda carecem de padronização metodológica para que intervenções baseadas em serious games sejam validadas como instrumento de Educação Alimentar e Nutricional.
Subject(s)
Humans , Child , Adolescent , Adult , Food and Nutrition Education , Video Games , Educational Technology , Games, Experimental , Gamification , Biomarkers , Feeding Behavior , Noncommunicable Diseases , Treatment Adherence and ComplianceABSTRACT
Objetivo: Identificar fatores associados à adesão ao tratamento e ao seguimento da Profilaxia Pós-Exposição sexual em um município brasileiro. Métodos: Estudo transversal retrospectivo, com 476 pacientes que realizaram Profilaxia Pós-Exposição, em um Ambulatório de Doenças Crônicas Transmissíveis de um município brasileiro de grande porte, durante o ano de 2016. Os dados foram coletados em 2017, utilizando instrumento estruturado, e analisados pelo teste de Correlação de Person, considerando nível de significância de 95%. Resultados: Houve correlação discreta da "adesão ao tratamento" com "idade" (r=0,150; p=0,021), "Profilaxia Necessária" (r=-0,288; p=0,000) e "Resultado Teste de Hepatite C" (r=-0,263; p=0,000). Correlação moderada da "adesão ao tratamento" com "profilaxia realizada" (r=-0,313; p=0,000). Correlação discreta da "adesão ao seguimento" com "Idade" (r=0,170; p=0,010), "Histórico de Infecções Sexualmente Transmissíveis" (r=0,158; p=0,016), "profilaxia necessária" (r=-0,170; p=0,010) e "Resultado Teste de Hepatite C" (r=-0,142; p=0,026). Correlação baixa da "adesão ao seguimento" e "profilaxia realizada" (r=-0,183; p=0,006). Conclusão: A idade influenciou positivamente a adesão ao tratamento e a adesão ao seguimento. Houve casos adesão ao tratamento, sem adesão ao seguimento. (AU)
Objective: To identify factors associated with adherence to treatment and follow-up of Sexual Postexposure Prophylaxis in a Brazilian municipality. Methods: Retrospective cross-sectional study, with 476 patients who underwent Post-Exposure Prophylaxis, in a Chronic Transmissible Diseases Outpatient Clinic of a large Brazilian municipality, during the year 2016. Data were collected in 2017, using a structured instrument, and analyzed by Person's Correlation test, considering significance level of 95%. Results: There was discrete correlation of "treatment adherence" with "age" (r=0.150; p=0.021), "Prophylaxis Required" (r=- 0.288; p=0.000) and "Hepatitis C Test Result" (r=-0.263; p=0.000). Moderate correlation of "adherence to treatment" with "prophylaxis performed" (r=-0.313; p=0.000). Slight correlation of "adherence to follow-up" with "Age" (r=0.170; p=0.010), "History of Sexually Transmitted Infections" (r=0.158; p=0.016), "prophylaxis needed" (r=-0.170; p=0.010) and "Hepatitis C test result" (r=-0.142; p=0.026). Low correlation of "adherence to follow-up" and "prophylaxis performed" (r=-0.183; p=0.006). Conclusion: Age positively influenced treatment adherence and follow-up adherence. There were cases adherence to treatment, no adherence to follow-up. (AU)
Objetivo: Identificar los factores asociados a la adherencia al tratamiento y al seguimiento de la Profilaxis Postexposición en un municipio brasileño. Métodos: Estudio transversal retrospectivo de 476 pacientes sometidos a Profilaxis Postexposición en el Ambulatorio de Enfermedades Transmisibles Crónicas de un gran municipio brasileño en 2016. Los datos se recogieron en 2017 mediante un instrumento estructurado y se analizaron mediante la prueba de correlación de Person, considerando un nivel de significación del 95%. Resultados: Hubo una ligera correlación entre «adherencia al tratamiento¼ y «edad¼ (r=0,150; p=0,021), «Profilaxis requerida¼ (r=-0,288; p=0,000) y «Resultado de la prueba de hepatitis C¼ (r=-0,263; p=0,000). Correlación moderada entre «adherencia al tratamiento¼ y «profilaxis realizada¼ (r=-0,313; p=0,000). Discreta correlación de la «adherencia al seguimiento¼ con «Edad¼ (r=0,170; p=0,010), «Antecedentes de infecciones de transmisión sexual¼ (r=0,158; p=0,016), «profilaxis necesaria¼ (r=-0,170; p=0,010) y «Resultado de la prueba de la hepatitis C¼ (r=-0,142; p=0,026). Hubo una baja correlación entre «adherencia al seguimiento¼ y «profilaxis realizada¼ (r=-0,183; p=0,006). Conclusión: La edad influyó positivamente en la adherencia al tratamiento y la adherencia al seguimiento. Hubo casos de adherencia al tratamiento sin adherencia al seguimiento. (AU)
Subject(s)
Post-Exposure Prophylaxis , Sexually Transmitted Diseases , HIV , Unsafe Sex , Treatment Adherence and ComplianceABSTRACT
Objetivo: esta investigación tuvo por objetivo describir la adherencia al tratamiento inmunosupresor en pacientes trasplantados renales. Material y métodos: estudio de tipo cuantitativo, descriptivo, transversal y observacional. Población: trasplantados renales asistidos en una institución de salud de la ciudad de Corrientes, en el período de marzo 2018 marzo 2023. Se utilizó un cuestionario confecciona-do a partir de 2 escalas de medición, ITAS e ITBS. La información recolectada se analizó mediante un programa informático Excel. Se encuestó a 23 pacientes trasplantados renales. Resultados: el 92% presentó adherencia al tratamiento inmunosupresor, la edad media fue de 43 años y el 57% son de sexo femenino. Con respecto a la variable que evalúa las barreras incontrolables para la adherencia al tratamiento inmunosupresor en los últimos tres meses, es relevante destacar que un 87% de los participantes informa una disminución en estas barreras, y en relación con la variable sobre las barreras controlables que perciben los pacientes para adherirse al tratamiento inmunosupresor en los últimos 3 meses, se observó que el 100% de los encuestados posee menor presencia de barreras controlables. Por último, la adherencia al tratamiento inmunosupresor según edad y sexo. Conclusión: se resalta una alta adherencia al tratamiento inmunosupresor en trasplante renal, 92% de los participantes. La mejora en las barreras incontrolables sugiere un avance positivo en la gestión del tratamiento. Aunque hay divergencias con otros estudios, la percepción mínima de barreras controlables indica un compromiso general de los pacientes (AU)
Objective: this research aimed to describe adherence to immunosuppressive treatment in kidney transplant patients. Material and methods: quantitative, descriptive, cross-sectional and observational study. Population: kidney transplant recipients assisted in a health institution in the city of Corrientes, in the period from March 2018 to March 2023. A questionnaire was used based on 2 measurement scales, ITAS and ITBS. The information collected was analyzed using an Excel computer program. 23 kidney transplant patients were surveyed. Results: 92% adhered to immunosuppressive treatment, the average age was 43 years and 57% were female. With respect to the variable that evaluates uncontrollable barriers to adherence to immunosuppressive treatment in the last three months, it is relevant to highlight that 87% of the participants report a decrease in these barriers, and in relation to the variable on controllable barriers that perceived by patients to adhere to immunosuppressive treatment in the last 3 months, it was observed that 100% of those surveyed have a lower presence of controllable barriers. Finally, adherence to immunosuppressive treatment according to age and sex. Conclusion: high adherence to immunosuppressive treatment in kidney transplantation is highlighted, 92% of participants. Improvement in uncontrollable barriers suggests positive progress in treatment management. Although there are divergences with other studies, the minimal perception of controllable barriers indicates a general commitment of patients (AU)
Objetivo: esta pesquisa teve como objetivo descrever a adesão ao tratamento imunossupressor em pacientes transplantados renais. Material e métodos: estudo quantitativo, descritivo, transversal e ob-servacional. População: receptores de transplante renal atendidos em uma instituição de saúde da cidade de Corrientes, no período de março de 2018 a março de 2023. Foi utilizado questionário baseado em 2 escalas de medida, ITAS e ITBS. A informação recolhida foi analisada através de um programa informático Excel. Fo-ram pesquisados 23 pacientes transplantados renais. Resultados: 92% aderiram ao tratamento imunossupressor, a média de idade foi de 43 anos e 57% eram do sexo feminino. Com relação à variável que avalia as barreiras incontroláveis à adesão ao tratamento imunossupressor nos últimos três meses, é relevante destacar que 87% dos participantes relatam diminuição dessas barreiras, e em relação à variável sobre barreiras controláveis que percebidas pelos adesão dos pacientes ao tratamento imunossupressor nos últimos 3 meses, observou-se que 100% dos pesquisados apresentam menor presença de barreiras controláveis. Por fim, adesão ao tratamento imunossupressor de acordo com idade e sexo. Conclusão: destaca-se a elevada adesão ao tratamento imunossupressor no transplante re-nal, 92% dos participantes. A melhoria nas barreiras incontroláveis sugere progresso positivo na gestão do tratamento. Embora existam divergências com outros estudos, a percepção mínima de barreiras controláveis indica um comprometimento geral dos pacientes (AU)
Subject(s)
Humans , Adult , Middle Aged , Kidney Transplantation , Transplant Recipients , Treatment Adherence and Compliance , Immunosuppressive AgentsABSTRACT
Introduction: With aging, there is an increased risk of suffering from different chronic diseases, including high blood pressure. Hypertension management must be carried out by health professionals, whether or not treatment involves medication. By controlling drug treatment, especially adherence, serious health problems for older people can be avoided. Objective: To determine the factors associated with adherence to arterial hypertension treatment in older adults who live at home. Materials and Methods: A quantitative and cross-sectional study was conducted in La Libertad Region, Peru, with 342 older adults living at home. For data collection, a sociodemographic profile form, anthropometric measurements, blood pressure measurements, the Mini-mental State Examination (MMSE) test, the Geriatric Depression Scale (GDS), and the Morisky Green Levine (MGL) adherence scale were used. In addition, descriptive and analytical statistics were used. Result: 57.60% of the participants did not adhere to the pharmacological treatment, and, in most of the sociodemographic variables examined, they did not adhere to pharmacological treatment in most cases. Likewise, a relationship between retirement in older adults and the MGL adherence scale score was identified. The study showed evidence linking treatment adherence and age (p=0.01), retirement status (p=0.05), and history of stroke (p=0.004). Discussion: Treatment adherence depends on sociodemographic and health factors for disease control and a healthy lifestyle. Conclusion: Older adults and their caregivers need guidance and education to improve adherence to pharmacological treatments.
Introducción: Con el envejecimiento, aumenta el riesgo de padecer distintas enfermedades crónicas, incluida la hipertensión arterial. El manejo de la hipertensión debe realizarlo profesionales de la salud, sea que el tratamiento incluya o no medicamentos. El control del tratamiento farmacológico, sobre todo la adherencia, evitará graves consecuencias para la salud de las personas mayores. Objetivo: Determinar los factores asociados a la adherencia al tratamiento de la hipertensión arterial en adultos mayores que viven en su hogar. Materiales y métodos: Estudio cuantitativo y transversal realizado en la región La Libertad, Perú, con 342 adultos mayores que viven en sus hogares. Para recoger la información, se utilizaron los instrumentos de perfil sociodemográfico, medidas antropométricas, medición de la tensión arterial, el miniexamen del estado mental, la escala de depresión geriátrica y la escala de adherencia de Morisky,Green y Levine (MGL). Además, se utilizaron estadísticas descriptivas y analíticas. Resultado: Se identificó que el 57,60% de los participantes no cumplían el tratamiento farmacológico en la mayoría de las variables sociodemográficas estudiadas. Asimismo, se identificó una relación entre la jubilación en adultos mayores y el puntaje en la escala MGL. El estudio mostró evidencias de una asociación entre la adherencia al tratamiento y la edad (p=0,01), estar jubilado (p=0,05) y tener antecedentes de accidente cerebrovascular (p=0,004). Discusión: La adherencia al tratamiento depende de factores sociodemográficos y de salud para el control de la enfermedad, además de un estilo de vida saludable. Conclusión: Los adultos mayores y sus cuidadores necesitan orientación y educación para mejorar la adherencia al tratamiento farmacológico.
Introdução: Com o processo de envelhecimento, aumenta o risco de sofrer de diversas doenças crônicas, incluindo hipertensão arterial. Esse manejo deve ser realizado por profissionais de saúde com tratamento com e sem medicamentos. O tratamento medicamentoso deve ser controlado, principalmente na adesão ao mesmo, pois evitará consequências graves à saúde do idoso. Objetivo: determinar os fatores associados à adesão ao tratamento da hipertensão arterial em idosos que residem no domicílio. Materiais e Métodos: Estudo quantitativo e transversal realizado na região de La Libertad, Peru, com 342 idosos que moram no domicílio. Para a coleta de informações foram utilizados os instrumentos de perfil sociodemográfico, medidas antropométricas, medida de pressão arterial, miniexame do estado mental, escala de depressão geriátrica e teste de Morisky-Green. Além disso, foram utilizadas estatísticas descritivas e analíticas. Resultado: Identificou-se que 57,60% dos participantes não aderiram ao tratamento farmacológico com a maioria das variáveis sociodemográficas estudadas. Da mesma forma, foi identificada relação com a aposentadoria em idosos e o teste de Morisky-Green. O estudo mostrou evidências de associação entre idade (p=0,01), estar aposentado (p=0,05) e ter sofrido acidente vascular cerebral (p=0,004) com a adesão ao tratamento. Discussão: a adesão ao tratamento depende de fatores sociodemográficos e de saúde para o controle da doença, além de um estilo de vida saudável. Conclusão: Os idosos e seus cuidadores necessitam de orientação e educação para melhorar a adesão ao tratamento farmacológico.
Subject(s)
Aged , Treatment Adherence and Compliance , Geriatric Nursing , HypertensionABSTRACT
O crescente número de pessoas idosas alavanca desafios e oportunidades para ações coletivas de promoção de qualidade de vida, e nesse contexto, a educação permanente pode ser um pilar para o envelhecimento saudável.Deste modo compreender peculiaridades, experiências, vontades, o que, quando e como pessoas mais velhas desejam aprender, passa a ser o ponto de partida das Universidades da Terceira Idade (U3I), possibilitando que o estudante mais velho, seja o principal responsável pelo seu aprendizado, tornando importante a iniciativa de compreender os motivos de adesão e aderência em U3Is. Objetivo: mapear os motivos de adesão dos participantes de um programa de U3I. Método: Esse estudo teve um delineamento qualitativo transversal de questionário semiestruturado autoaplicável. A amostra de 118 participantes foi composta por demanda espontânea dos alunos matriculados em uma U3I, com média de idade de 70,45 (± 9,88) anos, no qual majoritariamente a participação foi do público feminino (86%). Asrespostas foram transcritas para uma planilha de Excel e os dados foram submetidos à análise temática de conteúdo indutiva, categorização e contagem de frequência. Resultados: O principal motivo de adesão para os alunos, é a atividade física, porém de acordo com sua vivência e experiência dentro do programa, as percepções dos usuários comumente se modificam, sendo as "relações sociais" o motivo mais importante para permanecer dentro da U3I, principal razão da aderência. Conclusão:Os resultados encontrados neste estudo podem ser capazes de fomentar e expandir os conhecimentos sobre os fatores de adesão e aderência de pessoas idosas a U3Is, ampliando ainda mais o crescente movimento dessas universidades no país.(AU)
The growing number of older people due to demographic transition pose challenges and opportunities for collective actions to promote quality of life in old age, and in this context, permanent education can be a pillar for healthy aging. In this way, to understand their peculiarities, experiences, wishes, which, when and how they want to learn, becomes the starting point of the Universities of the Third Age (U3A). Allowing the older student to be the main responsible for their learning process, making the initiative to understand the reasons for enrollment and adherence in U3As is therefore, quite important. Objective: to map the reasons for membership of participants in a U3A program. Method: This study had a qualitative cross-sectional design with a self-administrated questionnaire (survey). The sample of 118 participants was composed of spontaneous demand from students enrolled in a U3A, with a mean age of 70.45 (± 9.88) years, in which the majority of the participants were female (86%). The answers were transcribed to an excel spreadsheet and the data were subjected to thematic analysis of inductive content, categorization and frequency counting. Results: The main reason for enrollment is "Physical Activity", but according to their experience within the program, the perceptions of users commonly change, with "Social Relations" being the most important reason to stay within the U3A, main reason for adherence. Conclusion: The results of this study may contribute to a better understanding of the factors influencing older people's adherence to U3As, further promoting the growth of these universities in the country.(AU)
Subject(s)
Male , Female , Aged , Aged, 80 and over , Alprazolam , Aged , Treatment Adherence and Compliance , Healthy AgingABSTRACT
Introducción. La evidencia muestra una relación bidireccional entre la depresión y la enfermedad coronaria. La identificación de síntomas depresivos en la consulta de rehabilitación cardiovascular (RCV) puede ser un indicador valioso. Materiales y métodos. Aquellos pacientes que presentaron síntomas depresivos (autorreportados) fueron remitidos al servicio de Salud Mental (SM), y posteriormente se compararon con un grupo de pacientes sin estos síntomas y se evaluó su impacto en variables cardiovasculares. Resultados. Se evaluaron 60 pacientes. Se observó una adherencia del 86,44% (n=51). 13 pacientes fueron remitidos al área de HM (edad media 67,08 años; DE 6,09). Hemos analizado el impacto que puede representar este trastorno, tanto en la recuperación física como en la percepción de calidad de vida. Conclusiones. Los efectos positivos de la derivación a MH complementan los beneficios de la RCV. La mejora emocional del individuo también favorece la adherencia y el cumplimiento del tratamiento rehabilitador
Introduction. Evidence shows a bidirectional relationship between depression and coronary heart disease. The identification of depressive symptoms in the cardiovascular rehabilitation (CVR) consultation can be a valuable indicator. Materials and methods. Those patients who presented depressive symptoms (self-reported) were referred to the Mental Health (MH) service, and were subsequently compared with a group of patients without these symptoms, and their impact on cardiovascular variables was evaluated. Results. 60 patients were evaluated. An adherence of 86.44% (n=51) was observed. 13 patients were referred to the MH area (mean age 67.08 years; SD 6.09). We have analyzed the impact that this disorder can represent, both on physical recovery and on the perception of quality of life. Conclusions. The positive effects of referral to MH complement the benefits of CVR. The individual's emotional improvement also favors adherence and compliance with rehabilitation treatment
Subject(s)
Humans , Male , Female , Quality of Life/psychology , Depression/therapy , Cardiac Rehabilitation/psychology , Treatment Adherence and Compliance/psychologyABSTRACT
Introducción: a pesar de los avances en tratamiento antirretroviral, existe la posibilidad de que personas que viven con el virus de la inmunodeficiencia humana (VIH) experimenten falla terapéutica vinculada a múltiples factores que impactan en la respuesta al fármaco. Objetivos: evaluar la utilidad de aplicar un modelo farmacocinético en pacientes con diagnóstico de VIH en tratamiento con dolutegravir para el análisis de las concentraciones plasmáticas experimentales. Adicionalmente, se pretende identificar potenciales interacciones farmacológicas, evaluar adherencia y fallo terapéutico. Material y método: se realizó un estudio piloto transversal y observacional en pacientes VIH tratados con dolutegravir que incluyó la dosificación de la concentración plasmática, evaluación de adherencia mediante el cuestionario simplificado de adherencia a la medicación (SMAQ) y retiro de medicación. Se utilizó un modelo poblacional referenciado en la bibliografía para la predicción de concentraciones de dolutegravir en cada paciente y se compararon con las concentraciones experimentales. Resultados: fueron incluidos en el estudio 21 pacientes. Al cotejar las concentraciones plasmáticas experimentales con la simulación farmacocinética se encontraron diferencias para 12 pacientes, las cuales se explican por posibles interacciones farmacológicas, mala adherencia u otros factores que afectan la farmacocinética. Se detectó 38% de no adherencia de acuerdo con SMAQ y 23% de acuerdo con el retiro de medicación. Conclusiones: se expone el rol potencial de los modelos farmacocinéticos para la interpretación de concentraciones plasmáticas y se genera la necesidad de avanzar en este tipo de estudios para el establecimiento de rango terapéutico y aplicabilidad clínica.
Introduction: Despite advances in antiretroviral treatment, there is a possibility that people living with HIV may experience treatment failure linked to multiple factors that impact drug response. Objective: To evaluate the usefulness of applying a pharmacokinetic model in patients diagnosed with HIV undergoing treatment with dolutegravir for the analysis of experimental plasma concentrations. Additionally, the aim is to identify potential drug interactions, assess adherence, and therapeutic failure. Method: A cross-sectional, observational pilot study was conducted in HIV patients treated with dolutegravir, which included plasma concentration dosing, assessment of adherence using the Simplified Medication Adherence Questionnaire (SMAQ), and medication withdrawal. A population-based model referenced in the literature was used to predict dolutegravir concentrations in each patient and these were compared with experimental concentrations. Results: Twenty-one patients were included in the study. When comparing experimental plasma concentrations with pharmacokinetic simulation, differences were found for 12 patients, which can be explained by possible drug interactions, poor adherence, or other factors affecting pharmacokinetics. Non-adherence was detected in 38% according to the SMAQ and 23% according to medication withdrawal. Conclusions: The potential role of pharmacokinetic models in the interpretation of plasma concentrations is highlighted, emphasizing the need to advance in this type of studies to establish therapeutic ranges and clinical applicability.
Introdução: Apesar dos avanços no tratamento antirretroviral, existe a possibilidade de que pessoas que vivem com HIV experimentem falha terapêutica ligada a múltiplos fatores que impactam na resposta ao medicamento. Objetivos: Avaliar a utilidade da aplicação de um modelo farmacocinético em pacientes com diagnóstico de HIV em tratamento com dolutegravir para análise de concentrações plasmáticas experimentais. Além disso, pretende-se identificar potenciais interações medicamentosas, avaliar a adesão e a falha terapêutica. Método: Um estudo piloto observacional transversal foi conduzido em pacientes HIV tratados com dolutegravir que incluiu dosagem de concentração plasmática, avaliação de adesão usando o questionário simplificado de adesão à medicação (SMAQ) e retirada da medicação. Um modelo populacional referenciado na literatura foi utilizado para prever as concentrações de dolutegravir em cada paciente e compará-las com as concentrações experimentais. Resultados: 21 pacientes foram incluídos no estudo. Ao comparar as concentrações plasmáticas experimentais com a simulação farmacocinética, foram encontradas diferenças em 12 pacientes, que são explicadas por possíveis interações medicamentosas, má adesão ou outros fatores que afetam a farmacocinética. Foram detectadas 38% de não adesão segundo o SMAQ e 23% segundo retirada da medicação. Conclusões: Fica exposto o papel potencial dos modelos farmacocinéticos para a interpretação das concentrações plasmáticas e gera-se a necessidade de avançar neste tipo de estudos para estabelecer a faixa terapêutica e a aplicabilidade clínica.
Subject(s)
Antiretroviral Therapy, Highly Active , Anti-Retroviral Agents/pharmacokinetics , Drug Interactions , Treatment Adherence and ComplianceABSTRACT
Objetivo: Analisar o processo de implementação de educação em saúde às pessoas vivendo com HIV (PVHIV) em supressão viral parcial com vistas ao resgate da adesão à terapia antirretroviral. Métodos: Pesquisa Convergente Assistencial realizada com 13 pessoas infectadas pelo HIV, com supressão viral parcial. Por meio das etapas de concepção, instrumentação, perscrutação e análise, identificaram-se os motivos de falhas no tratamento, implementou-se educação em saúde e analisou-se o processo com entrevistas e análise de conteúdo. O processo educativo ocorreu com apoio de tecnologia educacional: Material Educativo sobre HIV (INPI: BR 10 2020 003765 0). Resultados: As falhas no tratamento deram-se pelos seguintes motivos: efeitos colaterais, preconceito, problemas familiares, dificuldade no acesso ao serviço de saúde e esquecimento. Das falas após intervenção, emergiram três categorias: 1 -O despertar para a importância do uso correto da terapia antirretroviral; 2 -Sentimentos advindos do processo educativo; 3 -O conhecimento e superação de estigmas sociais. Conclusão: A tecnologia educacional, somada à escolha de uma pesquisa participativa como método, proporcionou aprendizado para todos os envolvidos, sendo possível perceber a importância do fortalecimento do vínculo ensino-serviço, da utilização do diálogo no contextoda coletividade e da convergência investigativa para a prática assistencial
Objective:To analyze the process of implementing health education for people living with HIV in partial viral suppression with a view to rescuing adherence to antiretroviral therapy. Methods:Convergent Care Research carried out with 13 HIV-infected people, with partial viral suppression. Through the stages of conception, instrumentation, scrutiny and analysis, the reasons for treatment failures were identified, health education was implemented and the process was analyzed with interviews and content analysis. The educational process took place with the support of educational technology: Educational Material on HIV (INPI: BR 10 2020 003765 0). Results:Treatment failures were due to the following reasons: side effects, prejudice, family problems, difficulty in accessing the health service and forgetfulness. Three categories emerged from the speeches after the intervention: 1-Awakening to the importanceof the correct use of antiretroviral therapy; 2-Feelings arising from the educational process; 3-Knowledge and overcoming social stigmas. Conclusion:Educational technology, added to the choice of participatory research as a method, provided learning for all involved, making it possible to perceive the importance of strengthening the teaching-service bond, the use of dialogue in the context of collectivity and investigative convergence for care practice
Subject(s)
Health Education , Acquired Immunodeficiency Syndrome , HIV , Nursing , Treatment Adherence and ComplianceABSTRACT
The World Health Organization (WHO) has reported that there is an increasing burden of depression and other mental health conditions globally. WHO global health estimate for depression reports a prevalence of 5.4% in Sub-Saharan Africa. Pharmacological therapy still remains the most popular treatment for diagnosed depression. The aim of this study was to determine the prevalence of clinically diagnosed depression and outcomes of antidepressants among final year undergraduate students in a Federal University. A descriptive cross- sectional study was carried out at University of Benin, Benin City. A validated questionnaire was distributed to the 319 final year clinical students of the College of Medicine, School of Dentistry and Faculty of Pharmacy. Data obtained were organized and analysed with Microsoft Excel and SPSS version 25. Descriptive statistics was done; frequencies and percentages were used to summarize variables of interest. Ethical considerations were observed. All the questionnaires used were valid for analysis. About 90.0% of the respondents were knowledgeable about depression. Symptoms of depression were reported in 20.0% of the respondents with 16.6% having moderate symptoms of depression and 3.4% having moderately severe symptoms of depression. The same 20.0% used antidepressants and 14.7% did not adhere to their regimen. Side effects were experienced by majority of respondents (16.3%) on antidepressants. There was a low prevalence of depression in the study population. Adherence to drug therapy was poor. Side effects to treatment were reported by majority of students receiving antidepressants. Majority of patients claim to be better now that they are using antidepressant treatment as the symptoms of the disease are resolving.
Subject(s)
Humans , Male , Female , Surveys and Questionnaires , Depression , Treatment Adherence and Compliance , Students , Mental HealthABSTRACT
Esta pesquisa teve como objetivo investigar as perspectivas dos psicólogos dos Centros de Referência da Assistência Social (CRAS) que compõem a equipe de Proteção e Atenção Integral à Família (PAIF) a respeito do seu trabalho no Acompanhamento Familiar oferecido para famílias com membros com transtornos mentais. Oito psicólogos que atuavam nos CRAS de um município no interior de Minas Gerais participaram do estudo. O instrumento utilizado foi um roteiro de entrevista semiestruturada, com a subsequente análise de conteúdo temática. As categorias temáticas foram analisadas à luz da literatura específica da área. De maneira geral, os resultados indicaram que os psicólogos se sentem despreparados para o exercício de sua função no CRAS, uma vez que a formação específica e continuada em Psicologia não ofereceu subsídios adequados para o conhecimento da atuação no campo da Assistência Social. A natureza (psico)terapêutica do trabalho é discutida, assim como a necessidade de formações continuadas para a atuação. Ressalta-se a necessidade de mais pesquisas que abordem a formação em Psicologia e suas relações com a Assistência Social, bem como os impactos desse despreparo na prática dos profissionais, de maneira a fomentar maior satisfação pessoal/profissional e, consequentemente, aprimorar a assistência oferecida à comunidade.(AU)
This study aims to investigate the views of psychologists who worked at Social Assistance Reference Centers (CRAS) associated with the Comprehensive Family Care Program (PAIF) on their work with the aforementioned program. Overall, eight psychologists who worked at CRAS units in small municipalities in Minas Gerais for at least one year participated in this research. The instrument used was a semi-structured interview script, and the data were analyzed under the content analysis (thematic) method. Thematic categories were analyzed based on the specific literature. Results indicate that the psychologists generally felt unprepared to work at CRAS since their degree in Psychology provided inadequate knowledge to deal with Social Assistance issues. This study discusses the (psycho)therapeutic nature of their practice and the need for ongoing training for their proper performance. This study highlights the need for further research that addresses the links between education in Psychology and Social Assistance and the impacts of said unpreparedness on the performance of those professionals. Such research might provide more professional/personal satisfaction and, in turn, improve the quality of the offered service.(AU)
Este estudio tuvo la intención de conocer las perspectivas de los psicólogos de los Centros de Referencia de Asistencia Social (CRAS) que forman parte de los equipos del Protección y Atención Integral a la Familia (PAIF) acerca del seguimiento de familias con miembros portadores de trastornos mentales. Ocho psicólogos que actuaban en los CRAS de un municipio del interior del estado de Minas Gerais (Brasil) participaron en el estudio. El instrumento utilizado fue un guion de entrevistas semiestructuradas; y, para análisis de datos, se utilizó el análisis de contenido temático. Las categorías temáticas se analizaron a la luz de la literatura específica del campo. De modo general, los resultados indicaron que los psicólogos no se sienten preparados para desempeñar la función en el CRAS, puesto que la formación en Psicología no ofreció conocimientos adecuados para actuar en el campo de la asistencia social. Se discuten la naturaleza (psico)terapéutica del trabajo y la necesidad de formación continua para esta actuación. Se destaca la necesidad de más investigaciones que tratan de la formación en Psicología y sus relaciones con la asistencia social, y los impactos de esta falta de preparo en la práctica de los profesionales, de modo a promover una satisfacción personal/profesional y, consecuentemente, optimizar la asistencia ofrecida a la comunidad.(AU)
Subject(s)
Humans , Male , Female , Psychology , Psychology, Social , Social Support , Acting Out , Anxiety , Orientation , Patient Escort Service , Pensions , Personal Satisfaction , Poverty , Prejudice , Psychomotor Agitation , Public Policy , Quality of Life , Rural Population , Self Care , Self Mutilation , Social Behavior , Social Change , Social Identification , Social Problems , Social Responsibility , Social Sciences , Social Security , Social Welfare , Social Work , Socioeconomic Factors , Suicide , Behavioral Sciences , Health Policy, Planning and Management , Adaptation, Psychological , Family , Patient Acceptance of Health Care , Child Development , Residence Characteristics , Hygiene , Mental Health , Rural Health , Occupational Health , Treatment Refusal , Health Strategies , Self-Injurious Behavior , Patient Satisfaction , Negotiating , Family Planning Policy , Health Personnel , Disabled Persons , Domestic Violence , Comprehensive Health Care , Constitution and Bylaws , Community Networks , Continuity of Patient Care , Program , Persons with Mental Disabilities , Health Management , Creativity , Crisis Intervention , Personal Autonomy , State , Delivery of Health Care , Aggression , Depression , Diagnosis , Education , Ego , Emotions , Workforce , Humanization of Assistance , User Embracement , Health Care Facilities, Manpower, and Services , Family Conflict , Family Relations , Resilience, Psychological , Protective Factors , Sociological Factors , Problem Behavior , Work Performance , Psychosocial Support Systems , Treatment Adherence and Compliance , Work Engagement , Social Construction of Ethnic Identity , Adverse Childhood Experiences , Family Separation , Leadership and Governance Capacity , Solidarity , Social Protection in Health , Health Sector Stewardship and Governance , Indigenous Peoples , Empowerment , Psychosocial Intervention , Social Inclusion , Community Support , Social Vulnerability , Belonging , Diversity, Equity, Inclusion , Psychological Well-Being , Working Conditions , Workforce Diversity , Health Policy , Health Promotion , Health Resources , Health Services Accessibility , Human Rights , Interpersonal Relations , Object AttachmentABSTRACT
Introducción. La adherencia es parte importante de los programas de rehabilitación y constituye una medida indirecta del éxito de los mismos. Conocer la adherencia terapéutica y los factores relacionados a esta ofrece información valiosa para el diseño y la implementación de intervenciones que mejoren la adherencia misma y los resultados de los procesos de rehabilitación. Objetivo. Describir la adherencia terapéutica y los factores relacionados a esta en los pacientes admitidos al Proceso Interdisciplinario de Rehabilitación de la Clínica Universidad de La Sabana de Chía (Colombia). Métodos. Estudio observacional descriptivo. Los datos se recolectaron de forma consecutiva y por conveniencia de la población que asistió al Proceso Interdisciplinario de Rehabilitación entre enero de 2021 y marzo de 2023. Resultados. El estudio incluyó 352 participantes con una edad mediana de 24,5 años, quienes tuvieron una alta adherencia terapéutica (93,75%). El análisis multivariado mostró que para el grupo de adultos la variable relacionada con la adherencia fue la procedencia urbana (OR: 15,411, IC95%: 1,632-145,482; p=0,017) y para el de menores de edad mostró que la alternancia de múltiples cuidadores (OR: 0,035, IC95%: 0,003-0,415; p=0,008) o un cuidador definido que no participa en el tratamiento (OR: 0,008, IC95%: 0,0002-0,278; p=0,007) tenían asociación con la no adherencia. Conclusión. El estudio mostró alta adherencia, lo cual puede estar relacionado con las intervenciones realizadas a los cuidadores de manera temprana en el programa, así como con el grado de compromiso encontrado.
Objective. To describe therapeutic adherence and related factors in patients admitted to the Interdisciplinary Reha-bilitation Process of the Clínica Universidad de La Sabana in Chía (Colombia). Methods. Descriptive observational study. The data were collected consecutively and by convenience from the population who attended the Interdisciplinary Rehabilitation Process between January 2021 and March 2023. Results. The study included 352 participants with a median age of 24.5 years, who had high therapeutic adherence (93.75%). The multivariate analysis showed that for the group of adults, the variable related to adherence was urban origin (OR: 15.411, 95% CI: 1.632-145.482; p=0.017) and for the group of minors it showed that the alternation of multiple caregivers (OR: 0.035, 95% CI: 0.003-0.415; p=0.008) or a defined caregiver who does not participate in the treatment (OR: 0.008, 95% CI: 0.0002-0.278; p=0.007) were associated with non-adherence.Conclusion. The study showed high adherence, which may be related to the interventions carried out to the caregivers early in the program, as well as to the degree of commitment found.