A cross-sectional study on knowledge, attitude, and practice regarding diabetes mellitus in diabetic and non-diabetic population

Background: A chronic disease, such as diabetes, representing a substantial burden for the patient. To maintain good self-care, patients need to be qualified and able to accept decisions and self-manage the disease on a daily basis. A high level of knowledge about the disease empowers the patient to act as an equal partner in the management of the disease. Aim and Objectives: This study was aimed to assess the knowledge and awareness among diabetic and non-diabetic population toward diabetes mellitus, different knowledge domain, and to evaluate diabetic patients’ awareness toward anti-diabetic therapy, hypoglycemia management, and their practical approach toward diabetes mellitus control. Materials and Methods: This was a cross-sectional study based on validated self-administered questionnaires on diabetes mellitus awareness, knowledge, and practice performed on 100 subjects including 50 diabetic and 50 non-diabetic carried out in outpatient department in civil hospital after taking ethical committee approval. Results: In diabetic patients, 78% patients were aware of diabetes etiology which is more in male. About 65% patients of diabetic aware of medication knowledge, 60% patients aware of investigation knowledge, 45% patients aware of complication knowledge, and 60% patients aware of hypoglycemic symptoms. While in non-diabetic subjects, 60% aware about diabetes etiology which is more in female. About 50% non-diabetic subjects aware of medication knowledge, 60% aware of investigation knowledge, 30% subjects aware of complication knowledge, and 40% aware of hypoglycemic symptoms. Conclusion: The study highlighted the need of people for better health information through large scale awareness intervention regarding diabetes. There is definite need to empower patients with knowledge required to help them obtain maximum benefit from their treatment for diabetes.

Industry workers with hypertension and diabetes mellitus, the prevalence of self-reported adherence, and disease control

Abstract To evaluate the prevalence of self-reported drug adherence and factors associated, as well as clinical health outcomes, for industry workers with hypertension (HTN) and diabetes mellitus (DM). This was a cross-sectional study of 137 Brazilian industry workers with HTN and/ or DM. Self-reported adherence was assessed, and the disease control was defined through blood pressure and capillary glycemia values. Data were descriptively analyzed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. The prevalence of self-reported drug adherence was 79.6% and the prevalence of disease control was 53.8%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. The prevalence of self-reported drug adherence was high, but the prevalence of disease control was low and not associated with adherence, indicating that the self-reported adherence measure may be inaccurate. Our findings identify some factors that explain non-adherent behavior in the workforce.

Causes de réhospitalisation pour insuffisance cardiaque dans le service de cardiologie du CHU de Brazzaville (République du Congo) / The causes of rehospitalization for heart failure in the department of cardiology at the university hospital of Brazzaville (Republic of the Congo)

But: Identifier les causes de réhospitalisation pour insuffisance cardiaque (IC) Patients et méthode: cette étude transversale a été menée entre avril 2014 et mars 2015 dans le service de cardiologie du centre hospitalier universitaire de Brazzaville (République du Congo). Ont été inclus, les patients ayant des antécédents d'hospitalisation pour IC. Résultats: Quatre-vingt-onze patients, 54 femmes (59,3%) ont été inclus. Le sexe-ratio était de 0,7. La fréquence de réhospitalisation pour IC était de 19%. L'âge moyen était de 62 ± 16 ans (extrêmes: 24-89 ans). Le nombre moyen de réadmissions était de 2 ± 0,8 (extrêmes: 1 à 5), les réhospitalisation fréquentes (supérieur à 3) étaient de 33 (36,2%). Les patients présentaient un statut socioéconomique faible dans 59 cas (64,8%), et une hypertension artérielle dans 40 cas (43,9%). L'examen physique a retrouvé : une insuffisance cardiaque globale 77 cas (84,6%), une insuffisance cardiaque droite exclusive 5 cas (5,5%). Les causes de l'insuffisance cardiaque étaient: la cardiopathie hypertensive 40 cas (43,9%), la cardiomyopathie dilatée 28 cas (30,8%) et les valvulopathies 9 cas (10%). Les principales causes de réhospitalisation étaient: les écarts du régime hyposodé 64 cas (70,3%), la mauvaise observance du traitement 56 cas (61,5%), la grippe 15 cas (16,5%), la fibrillation atriale 12 cas (13,2%), débit de filtration glomérulaire réduite 12 cas (13,2%). La durée moyenne d'hospitalisation était de 11 ± 6,4 jours (extrêmes: 2-29). Le décès a été enregistré dans 5 cas (5,5%). Conclusion: L'absence de respect pour un régime pauvre en sodium et une mauvaise adhésion au médicament ont été les principales causes de réhospitalisation pour IC à Brazzaville. À cet égard, il est nécessaire de promouvoir l'éducation thérapeutique et d'améliorer l'accès au traitement.

Background: to identify the causes of readmission for heart failure (HF) Methods: this cross-sectional study was conducted in April 2014 to march 2015 in the department of cardiology, University Hospital of Brazzaville (Republic of the Congo). We had included, the patients who had a history of hospitalization for HF. Results: Ninety-one patients, 54 women (59.3%) were included. Sex-ratio was 0.7. The frequency of readmission for HF was 19%. The mean age was 62±16 years (range: 24-89). The average number of readmission was 2±0.8 (range: 1-5), the history of readmission ≥ 3, were 33 (36.2%). The patients were low socio-economic status in 59 cases (64.8%). In examination, patients were in congestive HF (n=77, 84.6%), right-sided HF (n=5). The causes of HF were: hypertensive heart disease (n=40, 43.9%), dilated cardiomyopathy (n=28, 30.8%), and valvular heart disease (n=9). The main causes of readmission were: excessive salt intake (n=64, 70.3%), poor drug-adherence (n=56, 61.5%), influenza (n=15, 16.5%), atrial fibrillation (n=12, 13.2%), reduced estimate glomerular filtration rate (n=12, 13.2%). The average length of hospitalization was 11±6.4 days (range: 2-29). The death was recorded in 5 cases (5.5%). Conclusion: No respect of low sodium diet and poor drug adherence, were the most causes of readmission for HF at Brazzaville. In regard of this facts, promoting therapeutic education is needed, and increasing access to treatment

Adherencia farmacológica en pacientes hipertensos / Drug Adherence in Hypertensive Patients

Introducción: La falta de adherencia al tratamiento farmacológico es la principal razón de los pobres resultados observados en el control de la hipertensión arterial. Si bien los tratamientos farmacológicos han demostrado su eficacia, se ha reportado una baja adherencia a estos. Objetivo: Determinar la adherencia farmacológica y control de la presión arterial. Métodos: Se realizó un estudio descriptivo de corte transversal en pacientes hipertensos del consultorio # 24 del Policlínico Universitario Cerro, durante el periodo comprendido de octubre del 2017 a marzo del 2018. Resultados: De un total de 198 pacientes hipertensos estudiados, se identificó mayor prevalencia de la hipertensión arterial en hombres 51 por ciento y del grupo etario, 65 años. Solo el 43,9 por ciento de los pacientes se encontraron adheridos al tratamiento farmacológico demostrado por el test de Morisky Green Levine, y las mujeres mostraron mayor adherencia farmacológica (28,2 por ciento), los esquemas terapéuticos de monoterapia y monodosis presentaron mayor adherencia farmacológica (34,8 por ciento y 27,7 por ciento respectivamente), con asociación significativa (p < 0.05). El 71,7 por ciento de los pacientes se encontraban controlados, de ellos el 41,9 por ciento estaban adheridos farmacológicamente, con asociación significativa (p < 0.05). Conclusiones: Menos de la mitad de los pacientes se encontraban adheridos farmacológicamente, los esquemas terapéuticos de monoterapia y monodosis, resultaron más eficaces para la adherencia farmacológica y el control de la hipertensión arterial está influenciado directamente por la adherencia farmacológica(AU).

Introduction: Lack of adherence to drug treatment is the main reason for the poor outcomes observed in the control of high blood pressure. Although drug treatments have proven effective, low adherence to these has been reported. Objective: To determine drug adherence and blood pressure control. Methods: A descriptive, cross-sectional study was carried out with hypertensive patients of the family medicine office # 24 of Cerro University Polyclinic, during the period from October 2017 to March 2018. Results: From among a total of 198 hypertensive patients studied, a higher prevalence of arterial hypertension was identified in men (51 percent) and in the age group 65 years or older. Only 43.9 percentf the patients reported adherence to drug treatment, as demonstrated by the Morisky Green Levine test, while the women showed higher drug adherence (28.2 percent). The treatment schemes of monotherapy and single doses presented higher drug adherence (34.8 percent and 27.7 percent, respectively), with significant association (p<0.05). 71.7 percent of the patients were controlled, of which 41.9 percent reported drug adherence, with significant association (p<0.05). Conclusions: Less than half of the patients reported drug adherence. The treatment schemes of monotherapy and single dose were more effective for drug adherence, while high blood pressure control is directly influenced by drug adherence(AU)

Clinical Characteristics, Drug Adherence to Antipsychotics and Medical Use Trends in Patients First Diagnosed with Psychotic Disorder: A Preliminary Study / 대한정신분열병학회지

OBJECTIVES: In this preliminary study, we investigated the clinical characteristics of patients who were first diagnosed with psychotic disorder and explored the impact of the adherence to antipsychotics on long-term medical use. METHODS: All national health insurance claims related to psychotic disorders including gender, age, income, and drug compliance, from January 1, 2008 to December 31, 2015, were examined. With trend test using Medication Possession Ratio (MPR), we compared the medical use between the compliant group (MRP≥0.8) and the comparative non-compliant group (0.2≤MPR<0.8). RESULTS: Among 28,095 participants in total, 16,239 patients (57.8%) were diagnosed as schizophrenia; the 30s were the most common (n=7,151, 25.5%). Drug compliance was generally low regardless of the diagnosis and was the lowest among 20s with the 40–60% range of income. The compliant group showed lower psychiatric and medical use than the comparative group in the following years (p<0.0001). CONCLUSION: These findings suggest that patients in the 20s and 30s with the 40–60% range of income, who are diagnosed with schizophrenia at the first psychiatric visit, may need more clinical and political attention. The results also emphasize the importance of initial drug adherence to antipsychotics in reducing long-term psychiatric costs.

Exercise and drug adherence for breast cancer survivors / 体力科学

The incidence of breast cancer is rising in Japan year by year; and seems to peak at a younger age range compared to Western countries. About one half of breast cancer patients in Japan are diagnosed in their 30s to 50s. Among the cancers that frequently occur during the most productive years of life, breast cancer is considered the most serious one for survivors. Breast cancer treatments consist of surgery, hormone therapy, chemotherapy and radiation therapy. However, since all of these treatments have potential side effects, patients often stop taking therapy due to the side effects. To prevent and minimize such side effects, exercise plays a very important role. Furthermore, gaining excess weight for survivors has a negative impact on their prognosis. Thus, it is important that appropriate exercise and weight control interventions are developed.

Variables Influencing Drug Adherence in Patients with Alzheimer's Disease

OBJECTIVES: Many patients with Alzheimer's disease have difficulty in taking their medicine by themselves and their poor drug adherence possibly results in aggravating various symptoms. The aim of this study was to assess the variables influencing drug adherence of Alzheimer's disease patients. METHODS: In a four-week period, 33 outpatients over 65 years old diagnosed with Alzheimer's disease were monitored. Drug adherences were assessed by the Medication Event Monitoring System (MEMS), the pill count, the clinician rating scale, and self-report. Agreements among adherence measures and the relationships between MEMS adherence and other clinical factors were assessed. RESULTS: The adherence rates for the MEMS, the pill count, the clinician rating scale and, self-report were 51.5%, 82.8%, 82.8%, and 87.9%. The Kappa coefficients were 0.382 (pill count vs. MEMS, clinician rating scale vs. MEMS) and 0.256 (self-report vs. MEMS). Males showed better adherence than females but the other clinical variables did not show significant differences between adherence group and non-adherence group. CONCLUSION: These findings suggest that clinicians should be concerned when assessing drug adherence in patients with Alzheimer's disease only by subjective reporting and pill counting since these methods may make patient's adherence underestimate. Clinicians should also take in mind that caregivers play an important role in improving adherence.

Adherence to drug therapy in kidney disease

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4 percent). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4 percent) at the baseline period of the study than after 1 year of the study (26.8 percent). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22 percent) was lower than the percentage of non-adherent patients who became adherent (50 percent). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.

Factores que inlluyen la adherencia a la suplemntación con sulfato ferroso durrante el embarazo / Factors influencing adherence to supplementation with iron sulfate during pregnancy

El uso de sulfato ferroso en la prevención de las anemias durante el embarazo es obligatorio y gratuito a la paciente por el SUMI, sin embargo, se desconoce el nivel de adherencia a la prescripción durante los controles prenatales y los factores que influyen en la falta de adherencia, la identificación de estos factores corresponde al objetivo de este trabajo. Se presenta un estudio tipo caso control llevado a cabo en 182 mujeres que se encontraban en su puerperio inmediato en el Hospital Materno Infantil Germán Urquidi entre agosto y septiembre del 2009, de las cuales 135 pacientes fueron catalogadas con mala adherencia (casos) y 47 con buena adherencia (controles). Se buscaron factores epidemiológicos, factores dependientes de la terapéutica, efectos adversos, relación médico-paciente y percepción/actitudes frente al medicamento. Resultados: La adherencia reportada fue del 26%. La falta de estudios de primaria completos (OR=2,12; p=0,0355), la presencia de náuseas (OR 3,05; p= 0,02) y el tiempo prolongado de tratamiento (OR 2,46; p=0,011) demostraron estadísticamente disminuir la adherencia a sulfato ferroso. Contribuyen con una buena adherencia la toma del medicamento en un horario regular (0R=0,49 p=0,01) y la confianza en el médico que prescribió el sulfato ferroso (OR 0,34 p=0,046). Para lograr una buena adherencia de las mujeres se debe reforzar la relación médico - paciente y la explicación sobre los efectos del medicamento de acuerdo al nivel de instrucción de la paciente.

The use of ferrous sulfate in the prevention of anemia during pregnancy is free and required for patients by the Universal Maternal Child Insurance (SUMI), however, the level of drug adherence at prenatal checkups and the factors influencing non-adherence are unknown. The purpose of this study is the identification of these factors. We present a case-control study of 182 women in the immediate postpartum period in the "German Urquidi Maternal Child Hospital" from August to September 2009, of which 135 patients were categorized with poor adherence (cases) and 47 women with good adherence (controls). We analyzed epidemiological factors, therapy-dependent factors, adverse effects, physician-patient relationships, and patient perception / attitudes towards medication. Results: The drug adherence was 26%. Incomplete primary education (OR = 2.12, p = 0.0355), presence of nausea (OR 3.05, p = 0.02) and the long time of treatment (OR 2.46, p=0.011) demonstrated a negative effect on drug adherence. Factors associated with good drug adherence were a strict regular dosing schedule (OR = 0.49, p = 0.01) and a trusting relationship with the prescribing physician (OR 0.34, p = 0.046). To achieve a good drug adherence should improve the relation doctor - patients and explanations about the drug's effects by level of education of the patient.