Impact of two or less missing treatment sessions on tDCS clinical efficacy: results from a factorial, randomized, controlled trial in major depression.

OBJECTIVES: Transcranial direct current stimulation (tDCS) is a neuromodulatory intervention with recent clinical trials showing promising results in major depression treatment. Although tDCS has some appealing characteristics (e.g., low cost, ease of use, and relatively benign profile of adverse effects), one important drawback of the technique is the need to deliver consecutive, repeated sessions for several weekdays. However, no study investigated whether absences during this acute treatment phase impact on tDCS efficacy, and, if so, whether absences should be considered dropouts, therefore increasing attrition. MATERIAL AND METHODS: To examine this issue, we used data from a randomized, factorial, sham-controlled tDCS study that recruited 120 depressed patients. In this trial, the acute treatment phase consisted of ten consecutive sessions delivered once daily from Monday to Friday; two nonconsecutive missed visits were allowed, with extra tDCS sessions being performed to complete the original number of sessions. RESULTS: Our main finding was that the procedure of granting one to two absences during the acute treatment phase did not impact on tDCS antidepressant efficacy. Moreover, out of 103 completers, only 41 (39.8%) patients presented no missing visits and 25 (24.3%) presented two absences. These patients did not differ in clinical and demographic characteristics; thus, absences were probably circumstantial (e.g., traffic congestion, personal obligations). CONCLUSIONS: Absences during the acute tDCS treatment phase are common, which support the use of flexible schedules in future tDCS trials as to minimize attrition. Also, further studies should access whether higher number of absences can compromise optimal tDCS efficacy.

Resilience and treatment adhesion in patients with systemic lupus erythematosus.

BACKGROUND: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune, rheumatic inflammatory disease that can cause significant morbidity with evident psychological impacts and obvious harm to quality-of-life that require the patient to adapt treatment. OBJECTIVE: Assessment of resilience and the self-reported treatment adhesion behaviors of patients with SLE, investigating which of these factors are associated to resilience. METHOD: Cross-sectional study of 40 women with SLE. A questionnaire with social demographic data, health history and the Wagnild Young Resilience Scale were used. RESULTS: 62.5% followed the medical treatment properly but 55% found it difficult. 27.5% of the patients presented low resilience, 57.5% medium and 15% high resilience. Resilience was associated in the chi-square test (p-value < 0.05) with the variables work, understanding SLE, trying to find out about SLE, following the treatment correctly, difficulty in following the treatment and stopping some activity because of the disease. In the correlation analysis, resilience was associated with age (-0.3960), number of working hours (0.5533), specialized treatment duration (-0.8103) and disease duration from diagnosis (-0.8014). CONCLUSION: Patients with high resilience tended to follow treatment correctly, tried to understand the disease and adhered more to the treatment to avoid risks and promote protection factors. Therefore knowledge of resilience in patients with SLE is necessary. It is important that the state takes necessary actions to facilitate access to treatment, to educational programs and to medical support. Awareness and counselling sessions must be initiated to develop and promote individual capacities to learn how to tackle with the disease for which psychological support of family and doctors can play a significant role.

Estudo de fatores associados à adesão ao tratamento não farmacológico em portadores de diabetes mellitus assistidos pelo Programa Saúde da Família, Ventosa, Belo Horizonte / A study of factors associated to non-pharmacological treatment delivered by the Family Health Program in Ventosa, Belo Horizonte, to carriers of diabetes mellitus

O diabetes mellitus vem se tornando um dos principais problemas de saúde pública no Brasil. Há vários fatores que podem contribuir para a baixa adesão ao tratamento. O objetivo deste estudo foi investigar a associação entre fatores educacionais, demográficos, socioeconômicos, de saúde, percepção da doença, suporte social e adesão ao tratamento não farmacológico em portadores de diabetes mellitus assistidos pelo Programa Saúde da Família do Centro de Saúde Ventosa, em Belo Horizonte. As informações foram obtidas através de entrevistas com 164 diabéticos que estavam aguardando o acolhimento do Centro de Saúde. Na análise univariada, verificou-se associação significante entre a adesão ao tratamento não farmacológico e baixa renda, local de residência, conhecimento sobre complicações, motivação com o tratamento, fazer parte de grupo de diabéticos e orientações recebidas pelo enfermeiro e fisioterapeuta. Após análise multivariada, as variáveis "motivação com o tratamento" e "faz parte de algum grupo de diabético" foram estatisticamente significativas para a adesão total (p<0,05). As variáveis "conhecimento sobre as complicações" e "local de residência - área de elevado risco" obtiveram limiar de significância estatística em relação à adesão total (p= 0,06), apresentando, no entanto, relação inversa.

Diabetes Mellitus is turning into one of the main public health problems in Brazil. Many factors may contribute to the low adherence to treatment. The objective of this study was to investigate the association between educational and social-economic factors and factors related to the health, the perception of disease, social support and adherence to non-pharmacological treatment of carriers of diabetes mellitus assisted in the family health program of the Health Center in Ventosa, Belo Horizonte. Data were collected in interviews with 164 diabetics who were waiting for assistance in the health center. Univariate analysis showed significant association between adhesion to the non-pharmacological treatment and low income; place of residence; knowledge about consequences; motivation with regard to the treatment; making part of a diabetics group and orientation received from the nurse and the physiotherapist. Multivariate analysis showed the variables " treatment motivation" and "part of some diabetics group", to be statistically significant as refers to the total adhesion (p <0,05). The variables "knowledge about consequences " and " place of residence - high risk area" were statistically significant as refers to the total adhesion (p < 0,06), however presenting an inverse relation.