Perception of uncontrolled blood pressure and non-adherence to anti-hypertensive agents in diabetic hypertensive patients.

We assessed the association between adherence to antihypertensive drug treatment and patient's perception of uncontrolled blood pressure (BP) in diabetic hypertensive subjects. This was a cross-sectional study that evaluated adherence to antihypertensives (Morisky questionnaire), patients' perception of abnormal BP, office BP, and ambulatory BP monitoring in diabetic hypertensive subjects. We evaluated 323 patients, 65.2% women, aged 56.5 ± 7 years, glycosylated hemoglobin (HbA1c) 8.0% (range, 6.9%-9.6%), diabetes duration of 10 years (range, 5-17 years). Adherence to drug treatment was 51.4%. Patients who reported hypertension-related symptoms (60.4%) had a lower level of adherence (P < .001). Non-adherence occurred four times more frequently in patients who reported hypertension-related symptoms (P < .001, adjusted for use of three or more anti-hypertensives, age, and duration of diabetes). Non-adherents had higher office diastolic BP (83.6 ± 11.9 vs. 79.8 ± 9.9; P = .003), but no difference between groups was observed considering systolic, diastolic, and mean BP evaluated by ambulatory BP monitoring. Low rates of adherence to antihypertensive drug treatment were observed in outpatient hypertensive diabetic subjects. Perception of uncontrolled BP levels was strongly and independently associated with non-adherence. Non-adherence determined repercussion on office BP that may have clinical implications in cardiovascular risk.

[Consultation-action: a nursing action methodology in the field of occupational health]. / Consulta-ação: uma metodologia de ação em enfermagem na área da saúde do trabalhador.

The construction of this article reflects our attempt to demarcate knowledge as a bracket for the actions and interventions of nursing in the area of the worker's health. We believe that the proposals of the educative and caring actions in the field of the worker's health become appropriate and effective when engaged to the relation work-health-sickness, allowing the joint action nurse-worker in the inquiry, recognition and resolution of identified problems. So, the Consulta-ação, by means of a method of joint action, rescues for nursing basic elements of the preventive intervention and the promotion of the worker's health.

[Intervention in the process of work-health-disease based on the Betty Neuman's systems model]. / Intervenção no processo trabalho-saúde-adoecimento baseada no Modelo de sistemas de Betty Neuman.

This article proposes a referential landmark directed to the worker's area, attempting to answer theoretical and methodological needs in this field of action and professional intervention. The controversy of the relation work-health-disease and its implications to nursing are very challenging and, at the same time, quite intriguing as we seek for its interrelationships. Therefore, we intend to unfold them adopting the structural path of The Neuman Systems Model, systematizing a proposal of nursing action compromised with the relation work-health-disease. Also, we wish to investigate stress factors at work, environment and individual resources to deal with them, and the goals established to the interaction between nurse and worker. This interaction is seen as fundamental to the proposal of educational and/or assistencial actions to the worker's health. It is our intention to contribute with information and propositions to induce reflective thought and debate about the subject.