Advancing elderly diabetes care: exploring the usability and acceptance of continuous glucose monitoring (CGM).

OBJECTIVES: This study aimed to evaluate the acceptability, usability, compliance, and satisfaction of Continuous Glucose Monitoring (CGM) among elderly diabetic patients. DESIGN: Utilizing a mixed-methods approach, the study involved 30 participants, averaging 74.79 years in age. Participants wore two CGM devices, and their experiences, along with survey data, were comprehensively analyzed to gauge the effectiveness of CGM in managing diabetes. RESULTS: The study demonstrated that -CGM- is highly usable and acceptable among elderly diabetic patients. Participants effectively utilized CGM to monitor and predict blood glucose trends, positively influencing their glucose control and lifestyle. The average adherence rate was found to be 81 %, indicating a substantial level of effective self-management and treatment decision-making. CONCLUSION: The study recommends developing CGM educational programs tailored for the elderly, educating healthcare professionals, expanding insurance coverage for CGM, and promoting real-time CGM technology to improve usability and acceptance among the elderly.

Factores asociados a la adherencia a la hemodiálisis y al tratamiento farmacológico en Perú / Factors associated with adherence to hemodialysis and pharmacologic treatment in Peru

Introduction: Inadequate adherence to pharmacological treatment and hemodialysis sessions leads to complications for patients with chronic kidney disease. Objective: To analyze the factors associated with adherence to hemodialysis and pharmacological treatment. Material and Method: This non-experimental, cross-sectional, correlational, and observational study was conducted following approval from the Ethics Committee. The population consisted of 90 patients, from which a sample of 71 was obtained. Information was collected through a questionnaire consisting of the Batalla and MMAS-8 tests. Statistical analysis was performed using Microsoft Excel 2016 and the Statistical Package for the Social Sciences 25. Resultados: 49.30% of patients showed adherence to hemodialysis sessions. However, 94.37% displayed a lack of adherence to pharmacological treatment. Factors associated with adherence to the sessions included age, knowledge about the disease, duration of hemodialysis, number of comorbidities, and number of medications. Factors associated with adherence to pharmacological treatment were knowledge about chronic kidney disease and the number of comorbidities.Conclusions: There is a higher probability of attending hemodialysis sessions when the patient is older, knows about the disease, and has been undergoing dialysis treatment for more than five years. There is a higher likelihood of low pharmaco-logical adherence when the patient has three or more comorbidities. Implementing educational intervention programs is recommended, along with considering strategies such as booklets or mobile phone alarms for medication intake and attendance at hemodialysis. (AU)

Introducción: La inadecuada adherencia al tratamiento farmacológico y las sesiones de hemodiálisis conllevan complicaciones para el paciente con enfermedad renal crónica. Objetivo: Analizar los factores asociados a la adherencia a la hemodiálisis y al tratamiento farmacológico. Material y Método: Diseño no experimental, transversal, correlacional y observacional, tras aprobación del Comité Ético. Población conformada por 90 pacientes, de la cual se obtuvo una muestra de 71. La información se recolectó mediante un cuestionario conformado por el test de Batalla y test MMAS-8. Se realizo análisis estadístico con Microsoft Excel 2016 y Statistical Package for the Social Sciences 25. Resultados: El 49,30% de los pacientes presentaron adherencia a las sesiones de hemodiálisis, sin embargo, el 94,37% tuvo falta de adherencia al tratamiento farmacológico. Los factores asociados con la adherencia a las sesiones fueron la edad, el conocimiento sobre la enfermedad, el tiempo de hemodiálisis, el número de comorbilidades y el número de fármacos. Los factores asociados con la adherencia al tratamiento farmacológico fueron el conocimiento sobre la enfermedad renal crónica, y el número de comorbilidades. Conclusiones: Existe mayor probabilidad de cumplir con las sesiones de hemodiálisis cuando el paciente es adulto mayor, tiene conocimiento sobre la enfermedad, y lleva más de cinco años en tratamiento dialítico. Existe mayor probabilidad de tener baja adherencia farmacológica cuando el paciente presenta de 3 a más comorbilidades. Se recomienda la implementación de programas educativos de intervención y considerar estrategias como cartillas o alarmas en celulares para el consumo de fármacos y la asistencia a la hemodiálisis. (AU)

Factores asociados a la adherencia al tratamiento en pacientes con anticoagulación oral

Introducción: El tratamiento con anticoagulantes ha demostrado su eficacia en la prevención de complicaciones cardioembólicas; sin embargo, la adherencia probablemente tiene el mayor impacto en la calidad de la anticoagulación. Objetivo: Determinar los factores que influyen en la adherencia al tratamiento anticoagulante y en la estabilidad del índice de estandarización internacional (INR). Métodos: Se realizó un estudio analítico, observacional y prospectivo que se corresponde con un estudio farmacoepidemiológico de utilización de medicamentos (Esquema Terapéutico), en pacientes con diagnóstico de trastornos de la coagulación, en el área de salud del municipio Manzanillo, entre el 1ro de septiembre de 2018 al 1ro de diciembre de 2020. Los datos de la investigación se obtuvieron de una entrevista y su historia clínica. Fueron utilizados el test del Xi-cuadrado (X2), t de Student, ANOVA y Kruskall Wallis, con un valor de p=0,05 durante el procesamiento estadístico. Resultados: Se constató un grado bajo de adherencia farmacoterapéutica en la población estudiada. Las variables sociodemográficas relacionadas con la adherencia terapéutica fueron el sexo, la escolaridad y la ocupación. Existe relación entre los recursos económicos, el conocimiento que tiene el paciente sobre su enfermedad, el cumplimiento del tratamiento no farmacológico y el cumplimiento del tratamiento farmacológico con la adherencia. Las reacciones adversas y la disponibilidad de los medicamentos fueron los factores dependientes del tratamiento relacionados con la adherencia. Las orientaciones del médico al paciente, el seguimiento del paciente y la relación médico-paciente, fueron los factores dependientes del médico. Conclusiones: Las cinco dimensiones de la adherencia terapéutica que plantea la OMS (factores socioeconómicos, relacionados con el paciente, relacionados con la enfermedad, relacionados con el tratamiento y relacionados con el sistema de salud) se asociaron con la adherencia al tratamiento y la estabilidad del índice de estandarización internacional.

Introduction: Anticoagulant therapy has demonstrated efficacy in preventing cardioembolic complications. However, adherence is probably the most important determinant of the quality of anticoagulation. Objective: The aim of this research wasto determine the factors that influence adherence to anticoagulation therapy and the stability of the international normalized ratio (INR). Methods: Between September 1, 2018 and December 1, 2020was conducted an analytical, observational andprospective study, corresponding to a pharmacoepidemiological study of drug utilization (Therapeutic Scheme). The object of this study were patients with a diagnosis of coagulation disorders, in the health area of the municipality of Manzanillo. The research data were obtained through an interview and their clinical history. The Xi-squared test (X2), Student's t-test, ANOVA and Kruskall Wallis were used, with a value of p = 0.05 in statistical processing. Results: As a result, a low level of pharmacotherapeutic adherence was observed in the studied population. The sociodemographic variables associated with adherence were sex, education and occupation. There was an association between economic resources, patients' knowledge of their disease, compliance with nonpharmacological treatment, and compliance with pharmacological treatment and adherence. Also, adverse drug reactions and drug availability were the treatment-related factors associated with adherence. And, physician orientation to the patient, patient follow-up, and physician-patient relationship were the physician-dependent factors. Conclusions: To sump up, the five dimensions of adherence proposedbyWHO (socioeconomic, patient-related, disease-related, treatment-related and health system-related factors) were associated with adherence and stability of the international standardization index.

Introdução: A terapêutica anticoagulante tem-se revelado eficaz na prevenção de complicações cardioembólicas. Objetivo: O objetivo desta investigação foi determinar os factores que influenciam a adesão à terapêutica anticoagulante e a estabilidade do rácio normalizado internacional (INR). Métodos: Um estudo analítico, observacional e prospetivo, correspondente a um estudo farmacoepidemiológico de utilização de medicamentos (Esquema Terapêutico) foi realizado entre 1 de setembro de 2018 e 1 de dezembro de 2020.O objeto deste estudo foram pacientes com diagnóstico de distúrbios de coagulação, da área de saúde do município de Manzanillo. Os dados da pesquisa foram obtidos através de uma entrevista e sua história clínica. Utilizou-se o teste do Xi-quadrado (X2), teste t de Student, ANOVA e Kruskall Wallis, com um valor de p = 0,05 no processamento estatístico. Resultados: Como resultado, observou-se um baixo nível de adesão à farmacoterapia na população estudada. As variáveis sociodemográficas associadas à adesão foram sexo, escolaridade e ocupação. Observou-se associação entre recursos financeiros, conhecimento da doença pelo paciente, adesão ao tratamento não farmacológico e adesão ao tratamento farmacológico e adesão. Além disso, as reacções adversas a medicamentos e a disponibilidade de medicamentos foram os factores relacionados com o tratamento associados à adesão. E a orientação médico-paciente, o acompanhamento do paciente e a relação médico-paciente foram os factores dependentes do médico. Conclusões: Concluindo, as cinco dimensões da adesão propostas pela OMS (factores socioeconómicos, relacionados com o doente, relacionados com a doença, relacionados com o tratamento e relacionados com o sistema de saúde) estiveram associadas à adesão e à estabilidade do índice de normalização internacional.

Validez y confiabilidad de un instrumento para identificar factores que influyen en la adherencia al tratamiento en personas con factores de riesgo cardiovascular

Introducción: Es necesario contar con instrumentos válidos y confiables para identificar los factores que influyen en la adherencia al tratamiento en personas con factores de riesgo cardiovascular. En Colombia, Bonilla y Gutiérrez diseñaron un instrumento que cuenta con validez facial y de contenido. Sin embargo, no se ha demostrado la validez de constructo. Objetivo: Determinar la validez de constructo y confiabilidad del instrumento, factores que influyen en la adherencia al tratamiento farmacológico y no farmacológico en personas con factores de riesgo cardiovascular. Metodología: Investigación metodológica. Participaron 694 personas con factores de riesgo de enfermedad cardiovascular residentes en tres ciudades de Colombia (Neiva, Espinal y Tunja). Se realizó un análisis factorial exploratorio (extracción de componentes principales y rotación Varimax), análisis factorial confirmatorio (estimación de máxima verosimilitud) y una prueba de confiabilidad global y por dimensiones (alfa de Cronbach y Test-retest). Resultados: El análisis factorial exploratorio reportó un instrumento de 30 ítems con estructura de 4 factores (varianza total acumulada de 42,6 %). Los índices de ajuste del modelo propuesto indicaron ajuste absoluto excelente y ajuste incremental aceptable. El alfa de Cronbach global fue 0,86, lo que indica alta confiabilidad. Discusión: El estudio proporciona evidencia de un instrumento más robusto que otras versiones. Los instrumentos estandarizados para medir factores que influyen en la adherencia pueden ser muy útiles para la investigación y la práctica si cumplen con pruebas psicométricas de fiabilidad y validez. Conclusión: Se pone a disposición de los investigadores y del personal de salud un instrumento válido y confiable. Se recomienda su uso en poblaciones similares a la de este estudio.

Introduction: It is necessary to have valid and reliable instruments to identify the factors that influence adherence to treatment in people with cardiovascular risk factors. In Colombia, Bonilla y Gutierrez designed an instrument that has face and content validity. However, construct validity has not been demonstrated. Objective: To determine the construct validity and reliability of the instrument, factors that influence adherence to pharmacological and non-pharmacological treatment in people with cardiovascular risk factors. Methodology: Methodological research. A total of 694 people with risk factors for cardiovascular disease residing in three Colombian cities (Neiva, Espinal and Tunja) participated. Exploratory factor analysis (extraction of principal components and Varimax rotation), confirmatory factor analysis (maximum likelihood estimation) and global and dimensional reliability test (Cronbach's alpha and Test-retest) were performed. Results: The exploratory factor analysis reported a 30-item instrument with a 4-factor structure (total cumulative variance of 42.6%). The fit indices of the proposed model indicated excellent absolute fit and acceptable incremental fit. The overall Cronbach's alpha was 0.86, indicating high reliability. Discussion: The study provides evidence of a more robust instrument than other versions. Standardized instruments to measure factors that influence adherence can be very useful for research and practice if they meet psychometric tests of reliability and validity. Conclusion: A valid and reliable instrument is made available to researchers and health personnel. Its use is recommended in populations similar to that of this study.

Factores relacionados con la adherencia al tratamiento de rehabilitación de los pacientes con Diabetes Mellitus tipo 2 con amputación de miembro inferior

Objetivo: Determinar los factores clínicos y sociodemográficos relacionados con la adherencia al tratamiento de rehabilitación de los pacientes con Diabetes Mellitus tipo 2 con amputación de miembro inferior. Material y métodos: Estudio observacional, retrospectivo, comparativo y relacional; se incluyeron 113 pacientes con DM tipo 2 del Departamento de Investigación, Docencia y Rehabilitación Integral en Amputados, quemados y Trastornos Posturales del Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERÚ - JAPÓN, que ingresaron en el periodo 2016 al 2019. Se recolectaron variables sociodemográficas y clínicas; y para la adherencia al tratamiento de rehabilitación se consideró la asistencia de los pacientes a 5 áreas de atención en salud, y el alta de prótesis de los pacientes. Resultados: El 75,52 % de pacientes fueron del sexo masculino, con edad media de 66,6 ± 12,1; y la media del tiempo de alta de prótesis fue 11,4 ± 6,75 meses. Se encontró diferencia significativa entre adherencia y no adherencia en la edad, nivel socioeconómico, estado civil y cobertura de atención (p < 0,05) Conclusiones: La mayoría de los pacientes amputados con DM tipo 2 fueron del sexo masculino cuyo cumplimiento o adherencia a la rehabilitación se relacionó con factores sociodemográficos como la edad, estado civil, nivel socioeconómico y cobertura de salud.

SUMMARY Objective: To determine clinical and sociodemographic factors related to the adherence to rehabilitation treatment among type 2 diabetic patients who underwent lower limb amputation. Methods: An observational retrospective study that included 113 type 2 diabetic patients attended at the Departamento de Investigación, Docencia y Rehabilitación Integral en Amputados, quemados y Trastornos Posturales del Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERÚ - JAPÓN from 2016 to 2019. Clinical and sociodemographic variables were collected; to measure adherence patients had to attend five evaluations and the discharge visit after a prosthetic device had been inserted. Results: 75.52% were males; mean age was 66.6 ± 12.1 years, and mean time after insertion of the prosthetic device was 11.4 ± 6.75 months. Factors associated with no adherence were age, socioeconomic level, marital status and health care coverage (p<0.05). Conclusions: Most of the type 2 diabetic patients who underwent lower limb amputation were males, adherence to the rehabilitation treatment was related to sociodemographic factors.

Adherencia al tratamiento y nivel de conocimiento en adultos con hipertensión arterial, Asunción 2022

Introducción: la adherencia al tratamiento y el nivel de conocimientos en pacientes con hipertensión arterial son factores claves para controlar esta afección y evitar complicaciones. Objetivos: determinar el grado de adherencia al tratamiento, el nivel de conocimientos y comorbilidades en pacientes con hipertensión arterial de un área urbana de Asunción, Paraguay, en 2022. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyeron varones y mujeres mayores de 18 años, conocidos portadores de hipertensión arterial, que residen en el barrio Sajonia entre mayo y octubre del 2022. Los datos fueron obtenidos con entrevistas realizadas casa por casa. Se midieron variables demográficas, el nivel de adherencia con el cuestionario de Morisky Green y el de conocimientos sobre la enfermedad con el cuestionario de Batalla. La investigación fue aprobada por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: participaron del estudio 425 sujetos, con predominio del sexo femenino (61,1%). La diabetes mellitus fue referida en 28,9% de los entrevistados. El cuestionario de Morisky Green detectó que 60% de los sujetos olvida de tomar su medicación, 25% no la toma en el horario indicado, 29% de la toma si se siente bien y 44% deja de tomarla si siente efectos indeseables. El cuestionario de Batalla halló 7% cree que la hipertensión arterial no es para toda la vida, 9% cree que la afección no se controla con dieta y medicación, y 5,8% no pudo referir al menos un órgano blanco. Conclusión: la adherencia al tratamiento de la hipertensión arterial y el nivel de conocimientos sobre esta afección no fue adecuada.

Introduction: Adherence to treatment and level of knowledge in patients with arterial hypertension are key factors to control this condition and avoid complications. Objectives: To determine the degree of adherence to treatment, the level of knowledge and comorbidities in patients with arterial hypertension in an urban area of ​​Asunción, Paraguay, in 2022. Methodology: An observational, descriptive, cross-sectional design was applied. Men and women over 18 years of age, known carriers of arterial hypertension, residing in Sajonia neighborhood between May and October 2022, were included. The data were obtained through house-to-house interviews. Demographic variables, the level of adherence with the Morisky Green test and the level of knowledge about the disease with the Batalla test were measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: Four hundred twenty-five subjects participated in the study, predominantly female (61.1%). Diabetes mellitus was referred to by 28.9% of the interviewees. The Morisky Green test detected that 60% of the subjects forget to take their medication, 25% do not take it at the indicated time, 29% take it if they feel well, and 44% stop taking it if they feel undesirable effects. The Batalla test found that 7% believe that arterial hypertension is not for life, 9% believe that the condition is not controlled with diet and medication, and 5.8% could not refer to at least one target organ. Conclusion: Adherence to the treatment of arterial hypertension and the level of knowledge about this condition was not adequate.

Adherencia a las medidas higiénico dietéticas de adultos con diabetes mellitus de Asunción en 2022

Introducción: la adherencia al tratamiento no farmacológico de la diabetes mellitus es un factor clave para evitar o retrasar las complicaciones de esta enfermedad. El cumplimento terapéutico depende de múltiples factores. Objetivo: evaluar la adherencia al tratamiento higiénico dietético en pacientes con diabetes mellitus, sobre todo la nutricional y la actividad física. Se midieron además las variables demográficas y presencia de hipertensión arterial. Metodología: se realizó una entrevista a pacientes adultos de ambos sexos, portadores de diabetes mellitus, que residen en el barrio Sajonia de Asunción, Paraguay, entre mayo y octubre del 2022. Se midieron variables demográficas y clínicas. La adherencia se determinó con el cuestionario de Caro Bautista que consta de 7 preguntas que evalúan las prácticas terapéuticas de los pacientes en la última semana. El estudio contó con la aprobación del Comité de ética de la Facultad de Medicina de la Universidad Privada del Este, Paraguay. Resultados: fueron entrevistados 257 personas con el diagnóstico de diabetes mellitus, con predominio del sexo femenino (61,4%), 73,9% refería tener ingresos propios y 49% padecía también de hipertensión arterial. El cuestionario detectó que 20,1% seguía una dieta saludable toda la semana, 15,5% realizaba ejercicios físicos diariamente y 14,3% realizaba los monitoreos de sangre capilar regularmente. Conclusión: entre 10 y 22% de los pacientes con diabetes mellitus realiza dieta y ejercicios adecuados, así como monitoreo de la glucemia según las recomendaciones de sus médicos.

Introduction: Adherence to non-pharmacological treatment of diabetes mellitus is a key factor in avoiding or delaying the complications of this disease. Treatment compliance depends on multiple factors. Objective: To evaluate adherence to dietary hygienic treatment in patients with diabetes mellitus, especially nutrition and physical activity. Demographic variables and the presence of arterial hypertension were also measured. Methodology: An interview was conducted with adult male and female patients, carriers of diabetes mellitus, residing in the Sajonia neighborhood of Asunción, Paraguay, between May and October 2022. Demographic and clinical variables were measured. Adherence was determined with the Caro Bautista questionnaire, which consists of seven questions that evaluate the therapeutic practices of patients in the last week. The study was approved by the Ethics Committee of the Faculty of Medicine of the Universidad Privada del Este, Paraguay. Results: Two hundred fifty-seven people diagnosed with diabetes mellitus were interviewed, with a predominance of females (61.4%), 73.9% reported having their own income and 49% also suffered from arterial hypertension. The questionnaire detected that 20.1% followed a healthy diet all week, 15.5% performed daily physical exercises, and 14.3% performed capillary blood monitoring regularly. Conclusion: Between 10 and 22% of patients with diabetes mellitus perform adequate diet and exercise, as well as glycemia monitoring according to the recommendations of their physicians.

Improving Access to Eye Care: A Systematic Review of the Literature.

PURPOSE: The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature. CLINICAL RELEVANCE: Health care disparities continue to plague the nation's well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age). METHODS: A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms "barriers and facilitators to health care," "access," and "disparities in general and sub-specialty eye care." Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria. RESULTS: Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH. CONCLUSIONS: The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.

Adherencia a la dieta sin gluten y calidad de vida en relación con la salud en los celiacos del Paraguay, 2021 / Adherence to a Gluten-Free Diet and Health-Related Quality of Life in Celiac Patients from Paraguay, 2021

Resumen Antecedentes: la calidad de vida en relación con la salud de las personas con enfermedad celiaca puede estar influenciada por la adherencia a la dieta sin gluten. Objetivos: describir las características demográficas y clínicas de los celiacos, evaluar la adherencia dietética con el cuestionario CDAT de Leffler y medir la calidad de vida autopercibida utilizando el cuestionario CD-QOL. Métodos y materiales: diseño observacional, transversal y prospectivo. Se aplicó una encuesta telemática a adolescentes y adultos de Paraguay diagnosticados con enfermedad celiaca, entre febrero y abril del año 2021, que accedieron a participar del estudio. La adherencia dietética se determinó con el cuestionario Celiac Dietary Adherence Test de Leffler y la calidad de vida con el CD-QOL de Dorn. Se midieron además variables demográficas y clínicas. La investigación fue aprobada por el Comité de Ética de la Universidad Privada del Este, en Paraguay. Resultados: la muestra estuvo constituida por 344 sujetos de estudio, de los cuales el 87 % pertenecía al sexo femenino. La edad media de los adolescentes fue de 15,1 años, y la de los adultos de 38±13 años. La adherencia a la dieta sin gluten se encontró en el 78 % (n=268) de los encuestados; fue buena en el 59 %, moderada en el 19 % y mala en el 22 % de los encuestados. La calidad de vida fue buena en el 30 % (n=103) de los sujetos y mala en el 70 % (n=241). Se encontró asociación entre los sujetos sin o mala adherencia a la dieta con la mala calidad de vida (p<0,006). Conclusión: en los celiacos estudiados, la mala adherencia a la dieta sin gluten se asocia con menor calidad de vida en relación con la salud.

Abstract Background: The health-related quality of life of people with celiac disease may be influenced by adherence to a gluten-free diet. Objectives: To describe the demographic and clinical characteristics of celiac patients, to evaluate dietary adherence with the Leffler CDAT questionnaire, and to measure self-perceived quality of life using the CD-QOL questionnaire. Material and Methods: Observational, cross-sectional, and prospective design. A telematic survey was applied to adolescents and adults in Paraguay, diagnosed with celiac disease, between February and April 2021, who agreed to participate in the study. Dietary adherence was determined with the Celiac Dietary Adherence Test of Leffler and quality of life with the test CD-QOL of Dorn. Demographic and clinical variables were also measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, in Paraguay. Results: The sample consisted of 344 study subjects of which 87% belonged to the female sex. The mean age of the adolescents was 15 ±1 years, and that of the adults was 38 ±13 years. Adherence to a gluten-free diet was found in 78% (n=268) of those surveyed, it was good in 59%, moderate in 19%, and bad in 22%. The quality of life was good in 30% (n=103) of the subjects and bad in 70% (n 241). It was found an association between subjects with no or bad adherence to the diet with bad quality of life (p<0.006). Conclusion: In the celiac patients studied, poor adherence to the gluten-free diet is associated with worse health-related quality of life.

Validez de constructo de la escala para evaluar la adherencia a procesos de neurorrehabilitación funcional (SMAN) en personas adultas / Construct validity of the Scale to Measure Adherence to functional Neurorehabilitation processes (SMAN) in adults / Validade de construto da escala para avaliar a aderência a processos de Neuroreabilitação Funcional (NRF) em adultos

Resumen Objetivo: Determinar la validez de constructo de la escala para evaluar la adherencia a procesos de neurorrehabilitación funcional (sman) en personas adultas Metodología: Estudio instrumental, con un diseño transversal, en el que se hace uso del método de análisis factorial confirmatorio para un modelo inicial de 5 factores y 20 ítems. Se utilizó el método de máxima verosimilitud y se realizaron pruebas de normalidad univariada y multivariada. El modelo hipotetizado se valoró con medidas de ajuste absoluto, ajuste incremental y ajuste de la parsimonia. Para el modelo definitivo, se calcularon estadísticos de fiabilidad, y validez convergente y discriminante, a través de matriz de correlaciones. Resultados: Para el modelo inicial (M0), los índices de modificación mostraron cargas cruzadas, pertenecientes a los constructos de "discapacidad" y "paciente"; por tanto, se hizo una revisión teórica de los ítems del instrumento y se eliminaron dos ítems redundantes, uno en cada factor. Posterior a la reespecificación del modelo (M2), la sman quedo conformada por 5 factores y 18 ítems. Conclusión: la sman posee propiedades psicométricas destacables y confiables para la medición de la adherencia en poblaciones con déficit funcional asociado a condición neurológica.

Abstract Objective: To determine the construct validity of the Scale to Measure Adherence to functional Neurorehabilitation processes (SMAN) in adults. Methodology: Instrumental study, with a cross-sectional design, in which the confirmatory factor analysis method was used for an initial model of 5 factors and 20 items. The maximum likelihood method was used and univariate, and multivariate normality tests were performed. The hypothesized model was evaluated with absolute, incremental and parsimony adjustment measures. For the definitive model, reliability and convergent and discriminant validity were calculated through a correlation matrix. Results: For the initial model (M0), the modification indices showed cross-loading related to constructs of "disability" and "patient". Therefore, a theoretical review of instrument items was made, and two redundant items were eliminated, one in each factor. After model re-specification (M2), SMAN was constituted by 5 factors and 18 items. Conclusion: SMAN has remarkable and reliable psychometric properties to measure adherence in populations with functional deficits associated with neurological conditions.

Resumo Objetivo: Determinar a validade de construto da escala para avaliar a aderência a processos de neuroreabilitação funcional (NRF) em adultos. Metodologia: Estudo instrumental com um desenho transversal, no qual se utiliza o método de análise fatorial confirmatória para um modelo inicial de 5 fatores e 20 itens. Foi utilizado o método de máxima verossimilhança e foram realizados testes de normalidade univariado e multivariado. O modelo hipotetizado foi avaliado com medidas de ajuste absoluto, ajuste incremental e ajuste da parcimônia. Para o modelo definitivo, foram calculados dados estatísticos de confiabilidade e validade convergente e discriminante, através de matriz de correlações. Resultados: Para o modelo inicial (MO), os índices de modificação mostraram cargas cruzadas pertencentes aos construtos de "incapacidade" e "paciente"; portanto foi feita uma revisão teórica dos itens do instrumento e foram eliminados dois itens redundantes, um em cada fator. Posterior à reespecificação do modelo (M2), a NRF foi formada por 5 fatores e 18 itens. Conclusão: A RNF possui propriedades psicométricas destacáveis e confiáveis para a medição da aderência em populações com déficit funcional associado à condição neurológica.

Clínica y tratamiento de la diabetes tipo 2 en adultos jóvenes en un hospital colombiano / Clinical presentation and treatment of type 2 diabetes in young adults in a Colombian hospital

Resumen Introducción: la diabetes mellitus tipo 2 (DM2) es el tipo más común de diabetes la cual ocurre generalmente en adultos, sin embargo, hay reportes que la describen en adolescentes y adultos jóvenes. Objetivo: describir las características clínicas y el tratamiento de la diabetes tipo 2 en adultos jóvenes en un hospital colombiano. Material y métodos: estudio de corte transversal entre el 2017 y 2019, que incluyó pacientes adultos jóvenes entre 18 y 40 años con DM2, que fueron atendidos en el Hospital Santa Mónica de Dosquebradas, Colombia. La unidad de análisis fueron las historias clínicas. Se incluyeron variables sociodemográficas, clínicas, farmacológicas y control metabólico (HbAlc < 7.0%). Se realizaron análisis descriptivos y se aplicó una regresión logística binaria (p< 0.05). Resultados: se identificaron 124 pacientes de los cuales 83 (70.0%) cumplieron criterios de inclusión, con una edad media de 33.7 ± 5.3 años. Unos 28 pacientes eran obesos (33.7%). Además, 21 pacientes (25.3%) presentaron control metabólico. Los fármacos más usados fueron metformina en 64 pacientes (77.1%), seguido de las insulinas en 46 pacientes (55.4%). Se estableció que 51 de estos (61.4%) presentaron adherencia al tratamiento. No hubo pacientes con terapia triple como estrategia terapéutica. Los pacientes con retinopatía diabética presentaban una probable asociación con tener control de la enfermedad en el momento del estudio (P=0.048, OR:0.130; IC95%:0.017-0.987). Conclusiones: los pacientes adultos jóvenes presentan pobre control metabólico y uso frecuente de insulinas. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1902).

Abstract Introduction: type 2 diabetes mellitus (T2DM) is the most common type of diabetes, generally occurring in adults. However, there are reports which describe it in adolescents and young adults. Objective: to describe the clinical characteristics and treatment of type 2 diabetes in young adults in a Colombian hospital. Materials and methods: a cross-sectional study from 2017 to 2019 which included young adult patients between 18 and 40 years old with T2DM who were seen at Hospital Santa Mónica in Dosquebradas, Colombia. The unit of analysis was the medical charts. Sociodemographic, clinical, pharmacological and metabolic control (HbA1c < 7.0%) variables were included. Descriptive analyses were performed, and binary logistic regression was applied (p<0.05). Results: 124 patients were identified, 83 (70.0%) of whom met the inclusion criteria, with a mean age of 33.7 ± 5.3 years. Some 28 patients were obese (33.7%). In addition, 21 patients (25.3%) had metabolic control. The most frequently used medications were metformin in 64 patients (77.1%), followed by insulin in 46 patients (55.4%). It was determined that 51 of these patients (61.4%) were compliant with treatment. No patients received triple therapy as a therapeutic strategy. Patients with diabetic retinopathy had a probable association with having the disease controlled at the time of the study (P=0.048, OR:0.130; 95%CI:0.017-0.987). Conclusions: young adult patients have poor metabolic control and frequent use of insulins. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1902).

Adherencia a medicación antineoplásica oral en oncología pediátrica. Estudio multicéntrico / Adherence to oral antineoplastic agents in pediatric oncology. A multicenter study

Objetivo. Determinar la adherencia de pacientes oncológicos pediátricos a la medicación oral del mantenimiento y conocer sus creencias sobre la medicación.Población y métodos. Durante 2018-19, se recogió información de padres, adolescentes y oncólogos en seis hospitales públicos pediátricos de la Argentina. Se administraron cuestionarios de adherencia (Simplified Medication Adherence Questionnaire) y de creencias sobre la medicación (Beliefs About Medicines Questionnaire). Se consideró adherente a quien refirió tomar la medicación sin saltear dosis y respetando el tiempo de ayuno.Resultados. N = 203 pacientes. La adherencia informada por los padres fue del 75 %; la estimada por los oncólogos, del 82 %, y la referida por adolescentes, del 45 %. Las variables que mostraron asociación con la adherencia fueron solvencia económica, diagnóstico, hospital tratante, cantidad de hijos a cargo, tratamientos oncológicos realizados y existencia de obstáculos en el cumplimiento. Esta muestra no percibía los medicamentos como dañinos, pero consideró que se los utilizaba abusivamente. La mayoría percibía la necesidad de tomar la medicación antineoplásica para mantener/recuperar la salud, pero también expresó preocupaciones. La percepción sobre la medicación fue similar entre los padres y los adolescentes, y no se asoció con el nivel de adherencia.Conclusiones. La adherencia informada por los padres en esta muestra fue del 75 %. Los padres y los pacientes percibían la medicación como necesaria y manifestaron preocupaciones vinculadas al tratamiento

Objective. To determine the adherence to oral maintenance medication among pediatric cancer patients and know their beliefs about medications.Population and methods. Information was obtained from parents, adolescents, and oncologists from six public children's hospitals of Argentina during 2018 and 2019. Questionnaires on adherence (Simplified Medication Adherence Questionnaire) and beliefs about medication (Beliefs About Medicines Questionnaire) were administered. Patients were considered adherent if they referred taking their medication without missing a dose and complying with fasting time.Results. N = 203 patients. Parent-reported adherence was 75 %; adherence estimated by oncologists, 82 %; and that referred by adolescents, 45 %. The outcome measures associated with adherence were financial solvency, diagnosis, treating hospital, number of children under the care of the caregiver, cancer treatments received, and presence of barriers in compliance. Sample subjects did not perceive medications as harmful, but considered they were overused. Most subjects perceived the necessity to take antineoplastic agents to maintain or recover their health, but also expressed their concerns. The perception about medication was similar between parents and adolescents, and was not associated with the level of adherence.Conclusions. In this sample, parent-reported adherence was 75 %. Parents and patients perceived a necessity for medication and expressed their concerns about treatment.

Adherence to oral antineoplastic agents in pediatric oncology. A multicenter study. / Adherencia a medicación antineoplásica oral en oncología pediátrica. Estudio multicéntrico.

OBJECTIVE: To determine the adherence to oral maintenance medication among pediatric cancer patients and know their beliefs about medications. POPULATION AND METHODS: Information was obtained from parents, adolescents, and oncologists from six public children's hospitals of Argentina during 2018 and 2019. Questionnaires on adherence (Simplified Medication Adherence Questionnaire) and beliefs about medication (Beliefs About Medicines Questionnaire) were administered. Patients were considered adherent if they referred taking their medication without missing a dose and complying with fasting time. RESULTS: N = 203 patients. Parent-reported adherence was 75 %; adherence estimated by oncologists, 82 %; and that referred by adolescents, 45 %. The outcome measures associated with adherence were financial solvency, diagnosis, treating hospital, number of children under the care of the caregiver, cancer treatments received, and presence of barriers in compliance. Sample subjects did not perceive medications as harmful, but considered they were overused. Most subjects perceived the necessity to take antineoplastic agents to maintain or recover their health, but also expressed their concerns. The perception about medication was similar between parents and adolescents, and was not associated with the level of adherence. CONCLUSIONS: In this sample, parent-reported adherence was 75 %. Parents and patients perceived a necessity for medication and expressed their concerns about treatment.

Objetivo. Determinar la adherencia de pacientes oncológicos pediátricos a la medicación oral del mantenimiento y conocer sus creencias sobre la medicación. Población y métodos. Durante 2018-19, se recogió información de padres, adolescentes y oncólogos en seis hospitales públicos pediátricos de la Argentina. Se administraron cuestionarios de adherencia (Simplified Medication Adherence Questionnaire) y de creencias sobre la medicación (Beliefs About Medicines Questionnaire). Se consideró adherente a quien refirió tomar la medicación sin saltear dosis y respetando el tiempo de ayuno. Resultados. N = 203 pacientes. La adherencia informada por los padres fue del 75 %; la estimada por los oncólogos, del 82 %, y la referida por adolescentes, del 45 %. Las variables que mostraron asociación con la adherencia fueron solvencia económica, diagnóstico, hospital tratante, cantidad de hijos a cargo, tratamientos oncológicos realizados y existencia de obstáculos en el cumplimiento. Esta muestra no percibía los medicamentos como dañinos, pero consideró que se los utilizaba abusivamente. La mayoría percibía la necesidad de tomar la medicación antineoplásica para mantener/recuperar la salud, pero también expresó preocupaciones. La percepción sobre la medicación fue similar entre los padres y los adolescentes, y no se asoció con el nivel de adherencia. Conclusiones. La adherencia informada por los padres en esta muestra fue del 75 %. Los padres y los pacientes percibían la medicación como necesaria y manifestaron preocupaciones vinculadas al tratamiento.

Relación entre nivel de adherencia al tratamiento y apoyo social en pacientes con falla cardiaca / Relationship between Treatment Adherence Level and Social Support in Patients with Heart Failure / Relação entre nível de adesão ao tratamento e suporte social em pacientes com insuficiência cardíaca

Introducción: La falla cardiaca (FC) es una de las enfermedades cardiovasculares con mayor índice de hospitalizaciones en la unidad de cuidado intensivo. En esta enfermedad es imperativo determinar aquellos factores asociados con el reingreso, como la adherencia al tratamiento y el apoyo social. Objetivo: determinar la relación entre la adherencia al tratamiento y el apoyo social de pacientes con falla cardiaca. Método: se realizó un estudio correlacional, con muestreo no probabilístico; el tamaño de la muestra fue de 64 pacientes con diagnóstico de FC. Para la medición del nivel de adherencia, se utilizó la escala para evaluación de comportamientos de adherencia con un alfa Cronbach de 0,72, para medir la percepción del apoyo social; se empleó la escala Medical Outcomes Study Social Supportsurvey (MOS) con una alfa de Cronbach de 0,94. Se realizó un análisis descriptivo y, para establecer la relación del nivel de adherencia con el apoyo social, se aplicó la prueba de independencia de distribuciones categóricas de Fisher. Resultados: Los participantes, en su mayoría, se encontraron adheridos al tratamiento (56,2%); el índice global de apoyo social (media: 76,18) y sus dimensiones se encontraron en un rango medio. En cuanto a la asociación entre la adherencia al tratamiento, el apoyo social emocional (p: 0,006336) y el apoyo afectivo (p: 0,03025), esta fue moderada. Conclusiones: Existe asociación entre la adherencia y el apoyo social, por lo que es fundamental que el profesional de enfermería incluya la evaluación e intervención del apoyo social previo al alta del paciente, para optimizar los niveles de adherencia.

Introduction: Hearth Failure (HF) is one of the cardiovascular diseases with higher numbers of admissions in the ICU. In these diseases, it is a must to determine the factors associated with re-admission like the treatment adherence and social support. Objective: To determine the relationship between treatment adherence and social support in patients with HF. Methods: A correlational study with non-probabilistic sampling was conducted. The sample size was 64 patients diagnosed with HF. To measure the adherence level, the adherence behavior evaluation scale with a Cronbach's alpha of 0.72 was used. To measure the social support perception, the Medical Outcomes Study Social Supportsurvey (MOS) with a Cronbach's alpha of 0.94 was used. A descriptive analysis was carried out and in order to determine how the adherence level is related to the social support, the Fisher's test for categorical distributions was applied. Results: Most of the subjects showed a level of frequently an adhered to the treatment (56.2%). The global index of social support was found with values in a mean range (mean: 76.18). The association between the treatment adherence, social support (p: 0.006336) and affective support (p: 0.03025) was moderate. Conclusions: There is an association between the treatment adherence and social support. Therefore, it is pivotal that the nurse include the evaluation and intervention of social support before the patient's discharge in order to optimize the adherence levels.

Introdução: A insuAciência cardíaca (FC) é uma das doenças cardiovasculares com maior índice de internações na unidade de terapia intensiva. Nesta doença é imperativo determinar os fatores associados à readmissão, como a adesão ao tratamento e o suporte social. Objetivo: determinar a relação entre adesão a tratamento e o suporte social de pacientes com InsuAciência Cardíaca. Método: foi realizado um estudo correlacional, com amostragem não probabilística e tamanho da amostra de 64 pacientes com diagnóstico de IC. Para mensurar o nível de adesão, utilizou-se a Escala para avaliação de comportamentos de adesão com alfa Cronbach de 0,72; para medir a percepção do apoio social, usou-se a escala Medical Outcomes Study Social Supportsurvey (MOS) com alfa de Cronbach de 0,94. Realizou-se análise descritiva e, para estabelecer a relação entre o nível de adesão e o suporte social, foi aplicado o teste de independência de distribuições categóricas de Fisher. Resultados: a maioria dos participantes encontrava-se em nível de adesão frequente ao tratamento (56,2%); o índice global de apoio social (média: 76,18) e suas dimensões se encontraram em um rango médio. Quanto à associação entre adesão ao tratamento, suporte social emocional (p: 0,006336) e suporte afetivo (p: 0,03025) foi moderada. Conclusões: Há associação entre adesão e suporte social, pelo que é fundamental que o proAssional de enfermagem inclua a avaliação e intervenção do apoio social antes da alta, para aperfeiçoar os níveis de adesão.

Calidad de vida relacionada con la salud en sujetos con VIH / Health-Related quality of life in people with HIV / Qualidade de vida relacionada à saúde em sujeitos com HIV

Introducción: Desde la identificación del VIH se ha avanzado en el desarrollo de tratamientos más seguros y eficaces que aseguren la sobrevida de los sujetos afectados, siendo el reto de los profesionales sanitarios el mejoramiento de la calidad de vida relacionada con la salud de estos. Objetivo: Analizar la calidad de vida relacionada con la salud de una muestra de pacientes con VIH de Buenos Aires, Argentina. Método: Estudio analítico, transversal y cuantitativo realizado durante los meses de enero a marzo de 2020. Participaron un total de 144 sujetos. Se administraron los cuestionarios SF-36 y Morisky Green. Resultados: La muestra estuvo comprendida mayoritariamente por hombres, solteros, sin hijos y con estudios universitarios. El 49,30 % presentaba una buena adherencia al tratamiento. La Función física fue la dimensión mejor evaluada (92,19), mientras que la Vitalidad fue la peor percibida (61,42). El componente mental fue el más afectado. El sexo femenino, nivel de estudios primario, edad más alta, tenencia de hijos y la presencia de complicaciones se asociaron a una peor calidad de vida. Conclusiones: Se hace importante implementar acciones tendientes a mejorar la adherencia al tratamiento de los pacientes y promover estilos de vida favorecedores de la salud. Asimismo, el abordaje de los sujetos ha de ser integral, considerando las dimensiones psíquica, emocional, social y espiritual como parte de las áreas de atención. La calidad de vida debe ser un indicador de seguimiento para los profesionales sanitarios.

Introduction: Since the HIV was identified, more efficacious and safer treatments have been developed in order to ensure survival of people with the virus. The challenge to the health professionals is to improve the quality of life in relation to these patients' health condition. Objective: To analyze the health-related quality of life in a sample of HIV patients from Buenos Aires (Argentina). Methods: It is a quantitative, cross.-sectional, analytical study conducted from January to March 2020. In total, 144 subjects took part in this study. Questionnaires SF-36 and Morisky-Green were applied. Results: Most of the sample consisted of male subjects, single, without children and with college education. The physical function evaluation reported the best values (92.19), while vitality showed the worse evaluation (61.42). The mental component was the most affected one. Female gender, low schooling, been older, having children and health complications were associated with a worse quality of life. Conclusions: It is quite important to implement actions intended to improve the treatment adherence among the patients and to encourage styles of life that favor their health. Likewise, health professional must approach these patients in a comprehensive way, considering the psychic, emotional, social and spiritual dimensions as a part of the healthcare. The quality of life must be taken as a follow-up indicator by the health professionals.

Introdução: Desde a identicação do VIH houve avanços no desenvolvimento de tratamentos mais seguros e eficazes que garantam a sobrevivência dos sujeitos acometidos, sendo o desafio para os profissionais sanitários o melhoramento da qualidade de vida relacionada à saúde destes. Objetivo: Analisar a qualidade de vida relacionada à saúde de uma amostra de pacientes com HIV de Buenos Aires, Argentina. Método: Estudo analítico, transversal e quantitativo realizado durante os meses de janeiro a março de 2020. Participara um total de 144 sujeitos. Foram aplicados os questionários SF-36 e Morisky-Green. Resultados: a amostra foi composta principalmente por homens, solteiros, sem filhos e com estudos universitários. 49,30% tiveram boa adesão ao tratamento. A Função física foi a dimensão melhor avaliada (92,19), enquanto Vitalidade foi a pior percebida (61,42). O componente mental foi o mais afeitado. O sexo feminino, nível de escolaridade fundamental, idade mais avançada, tenência de filhos e presença de complicaçõesforam associadasà pior qualidade de vida. Conclusões: É importanteimplementarações que visem melhoraraadesão ao tratamento dos pacientes e promover estilos de vida saudáveis. Da mesma forma, a abordagem dos sujeitos deve ser integral, considerando as dimensões psíquica, emocional, social e espiritual como parte das áreas de atenção. A qualidade de vida deve ser um indicador de monitoramento para os profissionais sanitários.

Brechas en la atención de personas hipertensas en el Policlínico Julio Antonio Mella, Guanabacoa, 2016-2017 / Gaps in the care of hypertensive people in Julio Antonio Mella Polyclinic, Guanabacoa (2016-2017)

Introducción: Para lograr el control de la hipertensión arterial se requiere de la vigilancia de sus factores de riesgo, del manejo integral de la enfermedad y la eliminación de brechas que atentan contra la calidad del proceso de atención. Objetivo: Identificar las principales brechas que afectan el proceso de atención de las personas hipertensas en un área de salud del municipio Guanabacoa durante el periodo 2016-2017. Métodos: Se realizó una investigación descriptiva transversal, se aplicó un muestreo por conglomerado bietápico. En una primera etapa de los 41 consultorios se seleccionaron 10, y de estos se seleccionaron aleatoriamente las familias, quedando conformada la muestra por 1458 familias. Se entrevistaron 2297 personas mayores de 35 años. Resultados: El 42,5 por ciento de los entrevistados tenía antecedentes de hipertensión arterial, el 3,0 resultó presunto hipertenso, en el 54,5 por ciento no se encontraron evidencias. Existieron dificultades con la atención de estas personas, dado por problemas organizativos, de funcionamiento del sistema y de comportamiento individual. Las principales brechas fueron en el acceso (36,3 por ciento, seguimiento (28,5 por ciento) y control (17,5 por ciento). El 97,6 por ciento tenía indicado tratamiento farmacológico y el 28 por ciento de los no controlados en el momento de la medición de la presión arterial no estaban adheridos. Conclusiones: Las brechas relacionadas con el acceso a los servicios de salud, diagnóstico, seguimiento, tratamiento y control de los hipertensos, cuyo elemento común es la no búsqueda de atención, repercute en la calidad de la atención(AU)

Introduction: To achieve the control of high blood pressure requires the monitoring of its risk factors, the comprehensive management of the disease and the elimination of gaps that hamper the quality of the care process. Objective: Identify the main gaps that affect the care process of hypertensive people in a health area of Guanabacoa municipality during the period 2016-2017. Methods: A cross-sectional descriptive research was conducted, and a two-stage conglomerate sampling was applied. In a first stage of the 41 family doctor´s offices, 10 were selected, and of these families were randomly selected, with the sample being made up of 1458 families. 2297 people over 35 years old were interviewed. Results: 42.5 percent of the interviewees had a history of high blood pressure, 3.0 percent were suspected hypertensives, in 54.5 percent no evidence was found. There were difficulties with the care of these people, given by organizational problems, system functioning and individual behavior. The main gaps were access (36.3 percent), follow-up (28.5 percent) and control (17.5 percent). 97.6 percent had an indicated drug treatment and 28 percent of those not controlled at the time of blood pressure measurement were not attached. Conclusions: Gaps related to access to health, diagnostic, follow-up, treatment and control services for hypertensive in which the common element is care´s non-seeking have an impact on the quality of care(AU)

Knowledge of asthmatic disease as a pneumonia protective factor. / Conocimiento de la enfermedad asmática como factor protector de neumonía.

OBJECTIVE: To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. METHOD: observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). RESULTS: the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. CONCLUSIONS: A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

Conocimiento sobre enfermedad coronaria en familiares de pacientes con evento cardiovascular / Knowledge about coronary disease in relatives of patients with cardiovascular event

Objetivo: describir los conocimientos que refieren los familiares de sujetos con enfermedad cardiovascular, previo a la asistencia a un taller educativo. Materiales y métodos: estudio descriptivo en 103 familiares de pacientes con enfermedad cardiovascular, que participaron en talleres educativos relacionados con enfermedad coronaria entre marzo y agosto de 2013. Los talleres eran los siguientes: 1. La enfermedad coronaria; 2. Ejercicio en enfermedad cardiovascular; 3. Adherencia a medicamentos y 4. Factores psicosociales y enfermedad cardiovascular. Se compararon diferencias entre proporción de sujetos con conocimiento informal y formal en cada taller. Resultados:103 familiares participaron en los talleres (80% mujeres; edad promedio 49± 1.55años). El 39% refiere no tener ningún conocimiento respecto al tema a tratar. El 28% sí tiene conocimientos sobre el tema y la obtiene de fuentes informales como internet, diarios o revistas. Existió una proporción significativamente mayor de sujetos con conocimiento informal sobre ejercicio y adherencia a medicamentos. Conclusiones: estos resultados muestran que: hay poco conocimiento formal de enfermedad cardiovascular y del manejo de sus factores de riesgo, y alto nivel de apoyo del sexo femenino. La necesidad de educar, reforzar y aclarar el conocimiento para mejorar la adherencia al tratamiento y la prevención de nuevos eventos cardiovasculares, es un trabajo importante de enfermería, que debe desarrollarse prestando especial atención al entorno familiar del paciente..(AU)

Objective: to describe the knowledge referred by relatives of subjects with cardiovascular disease prior to attending an educational workshop. Materials and methods:descriptive study in 103 relatives of patients with cardiovascular disease, who participated in educational workshops related to coronary disease between March and August 2013. The workshops were the following: 1. Coronary disease; 2. Exercise in cardiovascular disease; 3. Adherence to medications and 4. Psychosocial factors and cardiovascular disease. Differences were compared between proportion of subjects with informal and formal knowledge in each workshop. Results: 103 relatives participated in the workshop (80% women, average age 49 ± 1.55 years). 39% report having no knowledge about the subject to be treated. 28% do have knowledge about the subject and get it from informal sources such as the internet, newspapers or magazines. There was a significantly higher proportion of subjects with informal knowledge about exercise and medication adherence. Conclusions: these results show that: there is little formal knowledge of cardiovascular disease and the management of its risk factors, and high level of support of the female sex. The need to educate, reinforce and clarify knowledge to improve adherence to treatment and the prevention of new cardiovascular events, is an important work of nursing, which should be developed paying special attention to the patient's family environment..(AU)

Fasting and Its Impact on Skin Anatomy, Physiology, and Physiopathology: A Comprehensive Review of the Literature.

Skin serves as the first protective line and barrier of the body. Like many other organs, skin can be affected by several disorders in response to external factors such as pathogens, ultraviolet light, and pollution, as well as endogenous alterations related to aging and/or oxidative stress disturbance. Researchers have reported new insights into how skin cells are altered in response to caloric restriction diets in mammals. One of the most well-known caloric restriction diets is the Ramadan intermittent fasting, which is a radical change in the diet plan of practitioners for the period of one lunar month. Ramadan fasting represents the fourth of the five pillars of the Islamic creed. Even though infirm individuals are waived to take part in this religious duty, patients with various health problems, including those with different skin disorders, might choose to share this event with peers and family members. No standardized protocols or guidelines exist, however, to advise their physicians on the proper management of their patients' condition during fasting. With an increasing Muslim population living in Western countries, this topic has started to draw substantial attention, not only of Middle-Eastern physicians, but also of clinicians in the West. For this purpose, we carried out a comprehensive overview on the topic. Our main findings are that: (1) there is a strong need for evidence-based suggestions and guidance. Literature on the impact of the Ramadan fasting, as well as of other kinds of fasting, on skin diseases is scarce and of poor quality, as well as the information available from the Internet; (2) patients willing to fast should be advised about the importance of taking proper treatments or consider alternative options including administration of trans-dermal/topical drugs, as they are permitted during daylight hours. Further, non-compliance has important, clinical and economic implications for an effective patient management.