Adesão ao tratamento medicamentoso anti-hipertensivo no Brasil: revisão sistemática e meta-análise / Adherence to antihypertensive drug treatment in Brazil: a systematic review and meta-analysis

Resumo O objetivo do artigo é avaliar a prevalência de adesão ao tratamento anti-hipertensivo na população brasileira, com base nos estudos revisados por pares, que utilizaram instrumentos elaborados e/ou adaptados exclusivamente para este fim. Revisão sistemática com meta-análise, baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, MEDLINE, e nos buscadores acadêmicos AgeLine, Google Scholar e ScienceDirect. O protocolo foi registrado no PROSPERO (CRD42021292689). Modelos de efeitos aleatórios foram usados para meta-análise das prevalências obtidas dos estudos individuais. Incluíram-se 104 estudos na meta-análise sobre tratamento anti-hipertensivo na população brasileira, totalizando 38.299 pacientes. O instrumento mais utilizado foi o teste de Morisky-Green de quatro itens (49,5%). A prevalência de adesão estimada pela foi de 44,4% (IC95%: 39,12%-49,94%, I2 = 91,17, p < 0,001), apresentando alta heterogeneidade. A prevalência de adesão ao tratamento anti-hipertensivo encontrada nos estudos nacionais foi insatisfatória, demonstrando que essa problemática continua sendo um grande desafio.

Abstract This article aims to evaluate the adherence to antihypertensive treatment prevalence in the Brazilian population based on peer-reviewed studies which used instruments exclusively designed and/or adapted for this purpose. A systematic review with meta-analysis based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was carried out in the BDENF, SciELO, Cuiden, PsycINFOe, CINAHL, Embase, LILACS, and MEDLINE databases, as well as the AgeLine, Google Scholar and ScienceDirect academic search engines. The protocol was registered with PROSPERO (CRD42021292689). Random effects models were used for a meta-analysis of the prevalence obtained from individual studies. A total of 104 studies were included in the meta-analysis on antihypertensive treatment in the Brazilian population, totaling 38,299 patients. The most used instrument was the four-item Morisky-Green Test (49.5%). The adherence prevalence estimated by the meta-analysis was 44.4% (95%CI: 39.12%-49.94%, I2 = 91.17, p < 0.001), showing high heterogeneity. The adherence to antihypertensive treatment prevalence found in national studies was unsatisfactory, demonstrating that this problem continues to be a major challenge.

Predictive Role of Resilience and Hope on Adherence to Treatment in Hemodialysis Patients / Papel predictivo de la resiliencia y la esperanza en la adherencia al tratamiento en pacientes en hemodiálisis / Papel preditivo da resiliência e da esperança na adesão ao tratamento em pacientes em hemodiálise

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.

Avaliação do autocuidado em diabéticos em duas unidades de saúde no município de Campinas (SP) / Evaluation of self-care among diabetics in two health units in the municipality of Campinas, São Paulo / Evaluación del autocuidado en diabéticos en dos centros de salud del municipio de Campinas, São Paulo

As doenças crônicas não transmissíveis (DCNT) são as principais causas de morbimortalidade no mundo, causando 738.371 óbitos em 2019 no Brasil. Entre elas, há a diabetes mellitus (DM), uma doença que acarreta a hiperglicemia, resultante da deficiência na secreção e/ou ação da insulina. Além das complicações, pacientes com DM apresentam elevado sofrimento emocional, incidindo sobre o autocuidado com o tratamento, a alimentação, a atividade física, entre outros aspectos que afetam sua qualidade de vida. Nessa perspectiva, este estudo objetiva avaliar a aderência ao autocuidado nos pacientes com DM cadastrados em dois Centros de Saúde no município de Campinas, em São Paulo. Estudo de caráter exploratório descritivo, a coleta de dados foi realizada a partir do Questionário de Atividades do Autocuidado com o Diabetes (QAD), adaptado e validado para a cultura brasileira a partir do The Summary of Diabetes Self-Care Activities Measure (SDSCA). Os dados foram analisados mediante tabulação no programa EPI INFO versão 3.5.1. A partir dos achados, os centros de saúde poderão fortalecer a linha de cuidado de indivíduos com diagnóstico de DM, direcionando as ações educativas na prevenção de complicações, permitindo maior independência e autonomia do paciente e aprimorando a adesão ao tratamento.

Chronic Non-Communicable Diseases (NCDs) are the main causes of morbidity and mortality worldwide. In 2019, 738,371 deaths were reported due to NCDs in Brazil. Among them is Diabetes Mellitus (DM), a disease that causes hyperglycemia from a deficiency in insulin secretion and/or action. In addition to complications, DM patients experience high emotional suffering which affects self-care treatment, nutrition, physical activity and other aspects that impact their quality of life. In this perspective, this study evaluates adherence to self-care treatment in DM patients registered in two health centers in Campinas, São Paulo. An exploratory, descriptive study was conducted using data collected by the Diabetes Self-Care Activities Questionnaire (QAD), adapted and validated for Brazil using the Summary of Diabetes Self-Care Activities Measure (SDSCA). Data were analyzed using tabulation in the EPI INFO program version 3.5.1. Based on the findings, health centers may strengthen their line of care for individuals diagnosed with DM, directing educational actions towards preventing complications, allowing greater patient independence and autonomy, thus improving treatment adherence.

Las enfermedades crónicas no transmisibles (ENT) están entre las principales causas de morbimortalidad en el mundo; en 2019 se reportaron en Brasil 738.371 muertes por ENT. Entre las ENT, se encuentra la diabetes mellitus (DM), una afección que causa hiperglucemia y que resulta de una deficiencia en la secreción y/o acción de la insulina. Además de sus complicaciones, los pacientes con DM experimentan un alto sufrimiento emocional, lo que afecta el autocuidado con el tratamiento, la nutrición, la actividad física y otros aspectos relacionados a la calidad de vida. Desde esta perspectiva, este estudio tiene como objetivo evaluar la adherencia al autocuidado en pacientes con DM registrados en dos centros de salud de la ciudad de Campinas, en São Paulo (Brasil). Se trata de un estudio exploratorio, descriptivo, en el cual la recolección de datos se realizó mediante el Cuestionario de Actividades de Autocuidado de la Diabetes (QAD), adaptado y validado para la cultura brasileña mediante el Resumen de las Actividades de Autocuidado de la Diabetes (SDSCA). Los datos se analizaron mediante tabulación en el programa EPI INFO, versión 3.5.1. Los hallazgos apuntan a que los centros de salud podrán fortalecer la línea de atención a las personas diagnosticadas con DM desde acciones educativas sobre la prevención de complicaciones, permitiendo mayor independencia y autonomía del paciente y mejorando así la adherencia al tratamiento.

Prevalencia de la no adherencia farmacológica en adultos con enfermedades crónicas en un centro médico de baja complejidad / Prevalence of pharmacological non-adherence in adults with chronic diseases in a low complexity medical center

Introducción: la falta de adherencia farmacológica, siendo un problema de salud pública es una de las principales causas de incremento de la morbimortalidad, discapacidad y costos sanitarios en los pacientes con enfermedades crónicas no transmisibles. Objetivo: describir la prevalencia de la no adherencia al tratamiento farmacológico de los pacientes adultos con patología crónica que asistieron a un centro médico de la ciudad de Tunja, desde septiembre a noviembre del año 2022. Materiales y métodos: estudio observacional de corte transversal que incluyó adultos mayores de 18 años con enfermedad crónica no transmisible en el servicio de consulta externa de un centro de salud de baja complejidad, se recolectó los datos de las historias clínicas, se utilizó estadística descriptiva y Odds Ratio para análisis de asociación. Resultados: se analizaron 216 pacientes. La prevalencia de no adherencia al tratamiento farmacológico fue del 75%, el promedio de edad de pacientes con patología crónica fue 65,5 años, el sexo femenino representó el 56,9%, la mayoría de los casos tuvieron hipertensión arterial sistémica (94,4%), más de la mitad presentaron comorbilidades (73,1%) y el 45,3% estaban polimedicados. Los factores relacionados con la no adherencia farmacológica según el test de Morisky-Green fueron edad menor a 60 años (p=0,033), sexo masculino (p=0,045), consumo de alcohol (p=0,003) y tabaco (p=0,003), ausencia de comorbilidades (p=0,008) y no polifarmacia (p=0,004). Conclusión: la no adherencia farmacológica presentó una prevalencia, por encima a la reportada en la literatura y el principal factor asociado fue el consumo de tabaco. Los resultados obtenidos proporcionan conocimientos para nuevas investigaciones (AU)

Introduction: lack of pharmacological adherence, being a public health problem, is one of the main causes of increased morbidity and mortality, disability and health costs in patients with chronic non-communicable diseases. Objective: to describe the prevalence of non-adherence to pharmacological treatment in adult patients with chronic pathology who attended a medical center in the city of Tunja, from September to November 2022. M aterials and methods: cross-sectional observational study that included adults over 18 years of age with chronic non-communicable disease in the outpatient service of a low-complexity health center, data was collected from medical records, descriptive statistics were used and Odds Ratio for association analysis. Results: 216 patients were analyzed. The prevalence of non-adherence to pharmacological treatment was 75%, the average age of patients with chronic pathology was 65.5 years, the female sex represented 56.9%, the majority of cases had systemic arterial hypertension (94,4%), more than half had comorbidities (73.1%) and 45.3% were polypharmacy. The factors related to pharmacological non-adherence according to the Morisky-Green test were age under 60 years (p=0.033), male sex (p=0.045), alcohol consumption (p=0.003) and tobacco (p=0.003), absence of comorbidities (p=0.008) and no polypharmacy (p=0.004). Conclusion: pharmacological non-adherence had a high prevalence above that reported in the literature and the main associated factor was tobacco consumption. The results obtained provide knowledge for new research (AU)

Adolescencia, adherencia y transición: Experiencia de un centro de trasplante renal pediátrico / Adolescence, adherence, and transition: Experience from a pediatric renal transplant center

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

The Effect of Motivational Interviewing on Oral Hygiene Behavior in Patients With Fixed Orthodontic Appliances: A Randomised Clinical Trial

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.

Efecto de COVID-19 en el tratamiento del cáncer cervicouterino: estudio antes/después / Effect of COVID-19 pandemics in treatment of cervical cancer: pre/post study

Resumen Introducción : Hay escasa evidencia sobre el impacto de la pandemia de COVID-19 en el cumplimiento del tratamiento de cáncer cervicouterino. Métodos : Se llevó a cabo un estudio poblacional de cohorte retrospectivo. -antes/después- de las pacientes con cáncer cervicouterino diagnosticadas en estable cimientos públicos de la provincia de Jujuy (n = 140), entre 2017 y 2020. Las pacientes diagnosticadas en 2020 se consideraron expuestas a la pandemia (n = 21). Utili zamos la regresión logística multivariada para analizar la asociación entre pandemia y cumplimiento del tra tamiento de cáncer. Además, se midió la duración del tratamiento en aquellas con indicación de braquiterapia y el tiempo hasta el inicio al tratamiento según estadio. Resultados : Comparadas con las mujeres diagnosti cadas en 2017-2019 el odds ratio de incumplimiento del tratamiento fue de 1.77 (IC95% 0.59-5.81; p = 0.32) para las diagnosticadas durante 2020. Se encontró un mayor riesgo de incumplimiento en pacientes con indicación de braquiterapia (OR 4.14; IC 95%:1.95-9.11; p < 0.001). La mediana de duración del tratamiento para aquellas con indicación de braquiterapia fue de 12.8 y 15.7 sema nas en 2017-2019 y 2020 respectivamente (p = 0.33). La mediana de tiempo hasta el inicio del tratamiento para pacientes con enfermedad en estadio temprano fue de 9 y 5 semanas durante 2017-2019 y 2020 respectivamente (p = 0.06), versus una mediana de 7.2 y 9 semanas en 2017-2019 y 2020 respectivamente (p=0.36) para las pa cientes con enfermedad en estadio IIB+. Conclusiones : El bajo acceso a la braquiterapia fue un factor determinante de incumplimiento de tratamiento de cáncer cervicouterino, independientemente del efecto de la pandemia.

Abstract Introduction : Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervi cal cancer treatment. Methods : We carried out a population-based, be fore-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initia tion by stage. Results : Compared with women diagnosed in 2017- 2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment dura tion for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. Conclusions : Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.

Adherencia de pacientes de alto riesgo heredo-familiar de cáncer de mama a "Programa de Vigilancia Activa": experiencia de la Clínica de Alto Riesgo de Cáncer de Mama del Centro Mamario del Hospital Universitario Austral / Adherence of patients with high hereditary-familial risk of breast cancer to the "Active Surveillance Program": experience of the High Risk Breast Cancer Clinic of the Breast Center of the Austral University Hospital

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)

Promoción de la adherencia al tratamiento antihipertensivo a través de un servicio de atención farmacéutica apoyado en telefonía móvil / Promoting of Adherence to Antihypertensive Treatment through a Pharmaceutical Care Service Supported by Mobile Phones / Promoção da adesão ao tratamento anti-hipertensivo através de um serviço de assistência farmacêutica apoiado por telefonia móvel

ntroducción: la hipertensión arterial continúa siendo un desafío para la salud pública del Paraguay. La falta de adherencia a los tratamientos es un problema desde los puntos de vista médico, económico y psicosocial. Objetivo: promover la adherencia al tratamiento farmacológico antihipertensivo en pacientes con hiperten-sión que asisten a servicio de salud público, mediante un servicio de atención farmacéutica apoyado en el uso de telefonía móvil. Materiales y métodos: estudio cuasiexperimental en pacientes mayores de 18 años de ambos sexos con hipertensión arterial, en quienes se aplicaron intervenciones farmacéuticas apoyadas con el uso de telefonía móvil (llamada, mensajería sms y WhatsApp) y en quienes se evaluó la adherencia al tratamiento mediante el cuestionario de Morisky-Green, junto con preguntas complementarias para cono-cer las causas de no adherencia. Resultados: participaron 60 pacientes. Al inicio, el 68.3 % (n = 41) mostró adherencia al tratamiento según el cuestionario de Morisky-Green, y el 31.7 % (n = 19) no cumplió con la indicación. Después de las intervenciones se ha encontrado una mayor adherencia al tratamiento, al llegar al 96.7 % los cumplidores (p < 0.001). Entre las causas de no adherencia a la farmacoterapia están el olvido (28.3 %; n = 17), la falta de disponibilidad del medicamento en el hospital (20 %; n = 12) y el costo (10 %; n = 6). Conclusión: la utilización de telefonía móvil como apoyo a la atención farmacéutica podría constituirse en una herramienta para la promoción de la adherencia en pacientes con hipertensión arterial.

Introduction: Arterial hypertension remains a public health challenge in Paraguay; lack of adherence to treatment poses medical, economic, and psychosocial concerns. Information and communication tech-nologies (ICT) are valuable tools in monitoring patients and improving adherence to drug treatment. Objective: Promote adherence to antihypertensive drug treatment among hypertensive patients who attend a public health service by implementing a pharmaceutical care service supported by mobile phones. Materials and methods: A quasi-experimental study was conducted in male and female patients aged 18 years and older with arterial hypertension, in which pharmaceutical interventions supported by mobile telephony (calls, SMS messaging, and WhatsApp) were applied and adherence to treatment was assessed using the Morisky-Green questionnaire with complementary questions to identify the reasons for non-adherence. The research protocol was approved by a Research Ethics Committee of the FCQ-UNA (714/2021). Results: A total of 60 patients participated. Initially, 68.3% (n=41) showed adhe-rence to treatment according to the Morisky-Green questionnaire, while 31.7% (n=19) did not adhere to the indication. After the interventions, an increase in adherence to treatment was observed, with a compliance of 96.7% (p<0.001). Reasons non-adherence to pharmacotherapy included forgetfulness 28.3% (n=17), unavailability of drugs at the hospital 20% (n=12) and cost 10% (n=6).Conclusion: The use of mobile phones to support pharmaceutical care has the potential to serve as a tool for promoting adherence in patients with arterial hypertension

Introdução: A hipertensão arterial continua a ser um desafio para a saúde pública no Paraguai; a falta de adesão aos tratamentos é um problema do ponto de vista médico, econômico e psicossocial. Objetivo:Promover a adesão ao tratamento farmacológico anti-hipertensivo nos doentes com hipertensão que frequentam os serviços públicos de saúde, através de um serviço de assistência farmacêutica apoiado na utilização de telefonia móvel. Materiais e métodos: Estudo quase experimental realizado em pacientes maiores de 18 anos de ambos os sexos com hipertensão arterial; em que foram aplicadas intervenções farmacêuticas apoiadas no uso da telefonia móvel (chamada, mensagem sms e WhatsApp) e a adesão ao tratamento foi avaliada por meio do questionário Morisky-Green, juntamente com perguntas comple-mentares para determinar as causas da não adesão. Resultados. 60 pacientes participaram. No início, 68,3% (n = 41) apresentaram adesão ao tratamento conforme questionário de Morisky-Green e 31,7% (n = 19) não cumpriram a indicação. Após as intervenções constatou-se maior adesão ao tratamento, com adesão chegando a 96,7% (p < 0,001), as causas da não adesão à farmacoterapia foram esquecimento em 28,3% dos casos (n = 17), falta de disponibilidade de medicamentos no hospital 20% (n = 12) e custo 10% (n = 6). Conclusão: a utilização de telefonia móvel para apoio à assistência farmacêutica poderá tornar-se uma ferramenta para promover a adesão ao tratamento em pacientes com hipertensão.

Adherencia de adultos de la compañía Chauria para la vacunación contra la COVID-19

Introducción: La pandemia del COVID-19 ha provocado cambios que afectan a los sistemas sanitarios y al enfoque de las enfermedades infecciosas en todo el mundo. La demanda de vacunas contra el COVID-19 se encuadra en un espectro que va desde el rechazo hasta la demanda, con una aceptación pasiva en el medio. Objetivo: Determinar la adherencia de los adultos a la vacunación contra la COVID-19. Chauria-Caballero, Paraguay 2022. Metodología: Estudio observacional, descriptivo, de corte transversal, con enfoque cuantitativo. El muestreo fue no probabilístico por conveniencia. La muestra estuvo conformada por un total de 225 adultos; los datos fueron recabados por medio de una encuesta elaborada por la investigadora, los datos fueron procesados con el software EPI INFO. Resultados: La mayoría de los sujetos de estudio se vacunaron, y hubo adherencia de la población a la vacuna contra la COVID-19 en un 93 %; diversos factores influyeron en las decisiones de estos; el porcentaje de adultos no vacunados mencionan como motivos su desconfianza (69 %) y el miedo/temor a la vacunación (31 %). Discusión: El estudio encontró una alta adherencia en general, la gran mayoría de los participantes vacunados contra COVID-19, porcentajes significativos se reportaron en Chile, China y Catar, cifras muy altas con relación a la aceptación de la vacuna a nivel país, teniendo una cobertura con un porcentaje mayor a la mitad con al menos una dosis.

Introduction: The coronavirus disease (COVID-19) pandemic has caused changes that affect health systems and the approach to infectious diseases worldwide. The demand for COVID-19 vaccines falls on a spectrum from rejection to demand, with passive acceptance in between. Objective: To determine the adherence of adults to vaccination against COVID-19. Chauria-Caballero, Paraguay 2022. Methods: This was an observational, descriptive, cross-sectional study using a quantitative approach. For convenience, the sampling was non-probabilistic. The sample comprised of 225 adults. The data were collected through a survey elaborated by the researcher, and the data were processed using EPI INFO software. Results: The majority of the study subjects were vaccinated, and there was 93% adherence of the population to the COVID-19 vaccine. Various factors influenced their decisions; the percentage of unvaccinated adults mentioned their distrust (69%) and fear of vaccination (31%). Discussion: The study found high adherence in general, the vast majority of participants were vaccinated against COVID-19, with significant percentages reported in Chile, China, and Qatar, very high figures in relation to the acceptance of the vaccine at the country level, with coverage of more than half with at least one dose.

Aplicación de un modelo farmacocinético poblacional para el seguimiento de pacientes en tratamiento con dolutegravir: estudio piloto / Application of a Population Pharmacokinetic Model for the Monitoring of Patients Undergoing Treatment with Dolutegravir: pilot study / Aplicação de modelo farmacocinético populacional para acompanhamento de pacientes tratados com dolutegravir: estudo piloto

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.

Adherence to treatment in patients with chronic kidney disease undergoing hemodialysis / Adesão ao tratamento de pacientes com doença renal crônica em hemodiálise

Objective: To identify the adherence to therapeutic regimens in patients with chronic kidney disease undergoing hemodialysis (HD). Method: This is a descriptive, cross-sectional study using a quantitative approach developed at an HD center in the south of Minas Gerais, Brazil. The study participants were 51 patients undergoing HD. Personal, socioeconomic, and objective data were collected, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was applied. The analysis was performed using simple descriptive statistics. Result: The average age was 56.7 years, and 58% of the patients were male. The percentages of non-adherence were diet (35.4%), hemodialysis (21.6%), fluid intake (15.7%), and medication (13.7%). Conclusion: Therapeutic adherence is a complex process that requires constant monitoring by a multidisciplinary team.

Objetivo: Identificar a adesão ao regime terapêutico de pacientes com doença renal crônica em hemodiálise. Método: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa, desenvolvido em um centro de hemodiálise situado no sul de Minas Gerais. Os participantes do estudo foram 51 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, socioeconômicos, objetivos aplicado o "Questionário de avaliação sobre a adesão do portador de doença renal crônica em hemodiálise". A análise foi realizada por meio de estatística descritiva simples. Resultado: A média de idade foi de 56,7 anos e 58% dos pacientes foram do sexo masculino. Os percentuais de não aderência encontrados foram dieta (35,4%), hemodiálise (21,6%), ingestão de líquidos (15,7%) e medicação (13,7%). Conclusão: A adesão terapêutica é um processo complexo, e por isso necessita de acompanhamento constante pela equipe multiprofissional.

Adherencia terapéutica de pacientes con diabetes mellitus tipo 2 en cuatro áreas de salud del país

Fundamento: El incumplimiento del tratamiento por las personas diabéticas, no solo empeora el pronóstico, sino su calidad de vida. Objetivo: Caracterizar la adherencia terapéutica en pacientes diabéticos tipo 2 pertenecientes a cuatro áreas de salud, de dos municipios de Cuba. Métodos: Se realizó un estudio descriptivo y transversal en dos áreas de salud de los municipios de Cárdenas y Santiago de Cuba, en el periodo enero - agosto de 2019. El universo estuvo representado por 1091 personas diabéticas que se recuperaron de un estudio previo efectuado entre el 2015 y 2016 en las mismas áreas de salud. A estas se les realizó mediciones antropométricas, de la presión arterial, hemoglobina glicada y se aplicó un cuestionario. Se estudiaron variables: sociodemográficas (edad, sexo, color de la piel, ocupación, nivel de escolaridad, convivencia), factores de riesgo y comorbilidades, tratamiento farmacológico y no farmacológico y su relación con la adherencia. Las variables categóricas fueron presentadas como frecuencias y porcentajes. Resultados: La adherencia fue de 70,7 %, relacionada estadísticamente con color de piel blanca, nivel de escolaridad alto, control de la hemoglobina glicada según edad y valor inferior a 7 %, así como, el no padecimiento de comorbilidades como enfermedades cardiovasculares, respiratorias crónicas, dislipidemia, no consumo de bebidas alcohólicas, ni azucaradas. Conclusiones: La no disponibilidad de medicamentos en farmacia, el olvido en tomarlos y en los horarios establecidos resultaron las principales barreras referidas por los pacientes, esto debe tenerse en cuenta para incidir de forma favorable en el control de la diabetes mellitus.

Foundation: Non-compliance with treatment by diabetic people not only worsens the prognosis, but also their quality of life. Objective: To characterize therapeutic adherence in type 2 diabetic patients belonging to four health areas, from two municipalities in Cuba. Methods: A descriptive and cross-sectional study was carried out in two health areas of the municipalities of Cárdenas and Santiago de Cuba, in the period January - August 2019. The universe was represented by 1091 diabetic people who recovered from a previous study carried out between 2015 and 2016 in the same health areas. They underwent anthropometric measurements, blood pressure, glycated hemoglobin and a questionnaire was applied. Variables were studied: sociodemographic (age, sex, skin color, occupation, level of education, cohabitation), risk factors and comorbidities, pharmacological and non-pharmacological treatment and their relationship with adherence. Categorical variables were presented as frequencies and percentages. Results: Adherence was 70.7 %, statistically related to white skin color, high level of education, control of glycated hemoglobin according to age and value less than 7 %, as well as not suffering from comorbidities such as cardiovascular diseases, chronic respiratory diseases, dyslipidemia, no consumption of alcoholic or sugary beverages. Conclusions: The non-availability of medications in the pharmacy, forgetting to take them and at the established times were the main barriers reported by patients, this must be taken into account to have a favorable impact on the control of diabetes mellitus.

Factores que influyen en la adherencia al tratamiento nutricional en pacientes hipertensos, Paraguay 2021 / Factors that influence adherence to nutritional treatment in hypertensive patients, Paraguay 2021

Introducción: el tratamiento nutricional está afectado por la conducta de los sujetos para generar adherencia. Objetivo: determinar factores que influyen en la no adherencia al tratamiento nutricional en pacientes hipertensos que acuden al Hospital Regional de Coronel Oviedo, 2021. Metodología: estudio descriptivo transversal. La población estuvo comprendida por pacientes registrados en el Programa de hipertensión arterial/Departamento cardiovascular del Hospital Regional de Coronel Oviedo. Se estudiaron los datos sociodemográficos, los factores de tratamiento nutricional y el grado de adherencia al tratamiento nutricional. Resultados: participaron del estudio 206 sujetos, el 53,4 % poseía 55 años o menos y el 81,1 % fue del sexo femenino. Se pudo hallar que solo el 3,8 % de los pacientes se adhieren al tratamiento. La no adherencia al factor conocimiento estuvo relacionado con el bajo nivel educativo (p=0,032), al factor equipo de salud con provenir del área rural y tener un bajo nivel educativo (p=0,006, p=0,002), al factor paciente con provenir del área rural (p=0.002), ser de bajo nivel educativo (p=0,008) y poseer obesidad grado II y III (p=0,036). La no adherencia global estuvo relacionada a estar casado (p=0.001) y realizar trabajos domésticos (p=0,009). Conclusiones: la adherencia al tratamiento es baja en la población de estudio.

Introduction: nutritional treatment is affected by the behavior of the subjects to generate adherence. This study was carried out to determine factors that influence non-adherence to nutritional treatment in hypertensive patients who attend the Coronel Oviedo Regional Hospital, 2021. Methodology: this was a cross-sectional descriptive observational study. The population was comprised of patients registered in the hypertension department of the Coronel Oviedo Regional Hospital. Sociodemographic data, nutritional treatment factors and the degree of adherence to nutritional treatment were studied. Results: 206 subjects participated in the study, 53.4 % were 55 years old or younger and 81.1 % were female. We found that only 3.8 % of patients adhere to treatment. Non-adherence due to the knowledge factor was related to low educational level (p=0.032), to the health team factor with coming from a rural area and having a low educational level (p=0.006, p=0.002), to the patient factor with coming from a rural area (p=0.002), to have a low educational level (p=0.008) and to have obesity grade II and III (p=0.036). Global non-adherence was related to being married (p=0.001) and doing housework (p=0.009). Conclusions: adherence to treatment is low in the study population.

Acceso y adhesión a proceso de intervención psicosocial diferenciado para los servicios y sistemas de salud en varones gay adultos viviendo con el VIH, Paraguay, 2022 / Access and adherence to a differentiated psychosocial intervention process for health services and systems in adult gay men living with HIV, Paraguay, 2022

Introducción: el acceso a los servicios de salud en Paraguay, está determinado por varios tipos de barreras. Por ello, es preciso describir el impacto que tienen las políticas públicas y sus implicancias en la mitigación de las mismas. Objetivo: describir el acompañamiento diferenciado y su contribución al apoyo socio emocional, adhesión al tratamiento y acceso a servicios de salud en el área de atención a personas varones que viven con el VIH. Metodología: estudio de carácter cualitativo, descriptivo, con entrevistas semi estructuradas y muestra no probabilística, dirigida e intencional; Resultados: este estudio cualitativo exploró las experiencias de personas viviendo con VIH que recibieron acompañamiento psicosocial diferenciado en un servicio de atención integral. Los participantes destacaron la importancia del acompañamiento para afrontar la crisis posterior al diagnóstico. La orientación presencial, escucha empática y seguimiento facilitaron la vinculación y adherencia al servicio de salud y al tratamiento antirretroviral. El apoyo psicosocial fue clave para desmitificar ideas erróneas sobre el VIH/SIDA, empoderarse sobre su estado serológico y mejorar la calidad de vida. Se enfatizó el rol de los grupos de pares para brindar contención. Algunos participantes reportaron experiencias previas de revelación no consentida y vulneración de confidencialidad. El acompañamiento psicosocial diferenciado resultó fundamental para facilitar la inserción y permanencia de las personas con VIH en los servicios de atención integral (adhesión al tratamiento). Conclusiones: el acompañamiento psicosocial diferenciado resultó clave para facilitar la vinculación y adherencia en personas con VIH. La atención integral requiere identificar situaciones particulares, establecer relaciones de confianza y comunicación efectiva. El apoyo inicial es fundamental brindando contención ante el impacto emocional del diagnóstico. El seguimiento continuo es esencial dada la doble discriminación. La confidencialidad y capacidad de generar vínculos empáticos son elementos centrales. Los factores mencionados favorecen la adhesión al tratamiento. Los resultados sugieren que estas prácticas psicosociales pueden optimizar modelos de atención integral a personas con VIH.

Introduction: access to healthcare services in Paraguay is influenced by various barriers. Thus, it is essential to describe the impact of public policies and their implications in mitigating these barriers. Objective: to describe the differentiated support and its contribution to socio-emotional support, therapeutic adherence, and access to healthcare services in the area of care for males living with HIV. Methodology: a qualitative, descriptive study with semi-structured interviews and a non-probabilistic, directed, and intentional sample. Results: this qualitative study explored the experiences of individuals living with HIV who received differentiated psychosocial support in an integrated care service. Participants emphasized the importance of support in coping with the post-diagnosis crisis. In-person guidance, empathetic listening, and follow-up facilitated engagement and adherence to healthcare services and antiretroviral treatment. Psychosocial support played a critical role in debunking misconceptions about HIV/AIDS, empowering individuals regarding their serostatus, and improving their quality of life. The role of peer groups in providing emotional support was emphasized. Some participants reported previous experiences of non-consensual disclosure and confidentiality breaches. Differentiated psychosocial support was essential in promoting the integration and retention of people with HIV in integrated care services (therapeutic adherence). Conclusions: differentiated psychosocial support was crucial in facilitating the engagement and adherence of individuals with HIV. Comprehensive care necessitates identifying specific situations, establishing trust-based relationships, and effective communication. Initial support is vital for providing emotional support in the face of the diagnostic impact. Ongoing follow-up is essential due to the dual discrimination faced. Confidentiality and the ability to build empathetic relationships are central elements. The aforementioned factors favor adherence to treatment. The results suggest that these psychosocial practices can enhance models of comprehensive care for people with HIV.

Adherencia a un programa alimentario dirigido a niños menores de 5 años, que asisten a un Hospital Materno Infantil de Asunción, Paraguay

Introducción. El Programa Alimentario Nutricional Integral (PANI) viene ejecutando acciones desde el año 2015 en servicios de salud de Asunción y años antes en otras regiones del país, con el fin de reducir los efectos negativos de la desnutrición; sin embargo, el éxito del PANI depende de la adherencia de los beneficiarios. Objetivo. Determinar la adherencia a un programa alimentario para el tratamiento de la desnutrición en niños menores de 5 años, ingresados en un Hospital Materno Infantil de Asunción, entre los años 2018 y 2021. Materiales y Método. Estudio observacional, descriptivo, de corte transversal. Se incluyeron todos los niños ingresados al PANI del Hospital Materno Infantil de elección entre los años 2018 y 2021, digitalizados en planilla Excel y analizados con el software Epi Info versión 7. Resultados. De 211 niños registrados se obtuvo datos de 166 pacientes con una edad media ± 1 de 1,3 años ± 1, 53% niñas, el 50% presentaba un ingreso familiar menor al salario mínimo. El 87,35% de los niños ingresó con riesgo de desnutrición, 10,84% con desnutrición moderada y 1,81% grave. La tasa de deserción fue de 67,5%. Conclusión. La adherencia al tratamiento de la desnutrición fue baja. La implementación del PANI como política de salud debe ser fortalecida y monitoreada permanentemente de forma a garantizar sus objetivos, abordando otras variables que puedan estar relacionadas a la deserción. Palabras clave: desnutrición infantil; programas y políticas de nutrición y alimentación; cumplimiento y adherencia al tratamiento.

Introduction. The Comprehensive Nutritional Food Program (PANI) has been carrying out actions since 2015 in health services in Asunción and years before in other regions of the country, in order to reduce the negative effects of malnutrition, however; the success of PANI depends of the beneficiaries' adherence. Objective. To determine adherence to a food program for the treatment of malnutrition in children under 5 years of age, admitted to a Maternal and Child Hospital in Asunción, between 2018 and 2021. Materials and Method. Observational, descriptive, cross-sectional study, with non-probabilistic sampling. Secondary data from children admitted to the PANI of the Maternal and Child Hospital of choice between 2018 and 2021 were included, digitized in an Excel spreadsheet and analyzed with the Epi Info version 7 software. Results. 166 samples participated in the study; The average age of the users was 1.3 years ± 1 SD. 53% were girls; 100% were of Latin ethnicity. 87.35% of children were admitted at risk of malnutrition, while moderate and severe malnutrition was 10.84% and 1.81% respectively. 50% had an income less than the minimum wage. Dropouts were 67.5% and admissions were 32.5%. Conclusion. Adherence to malnutrition treatment was low. The implementation of the PANI as a health policy must be strengthened and permanently monitored in order to guarantee its objectives, addressing other variables that may be related to dropout.

Factores asociados a la adherencia al tratamiento en niños de 1 a 3 años. Un estudio en el centro de salud "Señor de los Milagros" Huaycan - Ate / Associated factors with treatment adherence in children aged 1 to 3 years: a study at the "Señor de los Milagros" health center, Huaycan - Ate

RESUMEN Objetivo: Determinar los factores asociados a la adherencia al tratamiento en niños de 1 a 3 años en el centro de salud "Señor de los Milagros" Huaycán - Ate. Métodos: Este estudio observacional, retrospectivo y de corte transversal investigó la adherencia al tratamiento antianémico en 169 niños de 1 a 3 años diagnosticados con anemia, seleccionados de un grupo inicial de 300. Utilizando un formulario de recolección de datos, se evaluaron variables que abarcaban aspectos maternos, socioculturales, de tratamiento y del sistema de salud, mediante análisis bivariado y la prueba de Chi-cuadrado de Pearson. Resultados: Los resultados destacaron una baja adherencia al tratamiento, con solo el 4,7% de los niños mostrando alta adherencia y un 15,4% presentando no adherencia. Se observó una mayor adherencia en madres con educación secundaria, amas de casa y en convivencia con su pareja. Factores como la recepción de información comprensible, el trato respetuoso y la proximidad al centro de salud influían positivamente en la adherencia. Conclusión: Existe una asociación significativa entre la adherencia al tratamiento antianémico y los factores maternos, socioculturales y los relacionados con el tratamiento (p<0.05), sugiriendo que mejorar la comunicación, el soporte socioeconómico y la accesibilidad podría potenciar la adherencia terapéutica

ABSTRACT Objective: To determine the factors associated with treatment adherence in children aged 1 to 3 years at the "Señor de los Milagros" Health Center in Huaycán - Ate. Methods: This observational, retrospective, cross-sectional study investigated adherence to anti-anemic treatment in 169 children aged 1 to 3 years diagnosed with anemia, selected from an initial group of 300. Using a data collection form, variables covering maternal, sociocultural, treatment, and health system aspects were evaluated through bivariate analysis and Pearson's Chi-square test. Results: The results highlighted low treatment adherence, with only 4.7% of children showing high adherence and 15.4% demonstrating non-adherence. Higher adherence was observed in mothers with secondary education, homemakers, and those living with their partners. Factors such as receiving understandable information, respectful treatment, and proximity to the health center positively influenced adherence. Conclusion: There is a significant association between adherence to anti-anemic treatment and maternal, sociocultural, and treatment-related factors (p<0.05), suggesting that improving communication, socioeconomic support, and accessibility could enhance therapeutic adherence.

A national questionnaire survey on endoscopic treatment for gastroesophageal varices in portal hypertension in China / 中华消化内镜杂志

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Adherence and barriers to glaucoma topical medication / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate medication adherence among patients taking topical intraocular pressure(IOP)lowering treatment and ascertain if there are differences in medication adherence between patients treated by a glaucoma specialist and those who are followed up by a general ophthalmologist. Furthermore, to identify multiple obstacles contributing to poor adherence.METHODS: Cross-sectional survey study was conducted among a total of 54 patients, recruited from October 2020 to February 2021, who were using topical ocular hypotensive medication. Subjects completed a personalized questionnaire which was developed to evaluate medication adherence and its barriers.RESULTS: Approximately 60% of our subject population were not completely adherent to topical treatment. Pearson's Chi-squared test demonstrated that there was no significant association between adherence and being followed up by a glaucoma specialist or not(χ2=1.2468, P=0.5361). Furthermore, 43% of participants expressed having problems with eyedrop instillation and Logistic regression analysis revealed that those subjects were significantly more likely to be low adherent to treatment(β&#x0026;#xEE;=3.168, P=0.0367).CONCLUSION: The questionnaire was effective to evaluate medication adherence to topical IOP lowering treatment and its barriers. The medication adherence rate found in this study was remarkably low, so several strategies must be put into practice to deal with the most common obstacles related to poor adherence.

Analysis of medication adherence of hypertensive patients in medication consultation clinics and its influencing factors / 中国药房

OBJECTIVE To evaluate the medication adherence of patients with hypertension in medication consultation clinics， and to analyze its influencing factors. METHODS The data of 389 patients who visited the medication consultation clinics of our hospital from June 2021 to June 2023 were collected. Univariate and multivariate Logistic regression analysis were used to analyze the related factors affecting medication adherence of hypertensive patients or those receiving different types of drugs. RESULTS Among 389 patients with hypertension， 302 cases （77.63%） had good adherence. Multivariate Logistic analysis showed that higher education level [corrected OR＝2.25， 95%CI （1.29， 3.93）， P＝0.004] was positively correlated with medication adherence， average blood pressure level [corrected OR＝0.19， 95%CI （0.10， 0.37）， P＜0.001]， without complication [corrected OR＝0.47， 95%CI（0.26，0.84），P＝0.010] and antihypertensive drug regimen being free dose combination [corrected OR＝0.27，95%CI（0.15， 0.47）， P＜0.001] were negatively correlated with adherence. Results of univariate Logistic regression analysis showed that patients who used β-receptor blocking agents [OR＝1.65，95%CI（1.06，2.57），P＝0.027]， calcium channel blockers [OR＝2.13，95%CI（1.33， 3.42），P＝0.002] and agents acting on the renin-angiotensin system [OR＝2.04，95%CI（1.29，3.22），P＝0.002] had good medication adherence. CONCLUSIONS The medication adherence of hypertension patients needs to be improved. Hypertension patients with higher education level， lower average blood pressure level， complications and fixed-dose combination regimen and those who use agents acting on the renin-angiotensin system， calcium channel blockers and β-receptor blocking agents may have better medication adherence.