Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Cluster Randomized Controlled Trial.

BACKGROUND: There are no recent studies comparing the compliance rates of both patients and observers in tuberculosis treatment between the video-observed therapy (VOT) and directly observed therapy (DOT) programs. OBJECTIVE: This study aims to compare the average number of days that patients with pulmonary tuberculosis and their observers were compliant under VOT and DOT. In addition, this study aims to compare the sputum conversion rate of patients under VOT with that of patients under DOT. METHODS: Patient and observer compliance with tuberculosis treatment between the VOT and DOT programs were compared based on the average number of VOT and DOT compliance days and sputum conversion rates in a 60-day cluster randomized controlled trial with patients with pulmonary tuberculosis (VOT: n=63 and DOT: n=65) with positive sputum acid-fast bacilli smears and 38 observers equally randomized into the VOT and DOT groups (19 observers per group and n=1-5 patients per observer). The VOT group submitted videos to observers via smartphones; the DOT group followed standard procedures. An intention-to-treat analysis assessed the compliance of both the patients and the observers. RESULTS: The VOT group had higher average compliance than the DOT group (patients: mean difference 15.2 days, 95% CI 4.8-25.6; P=.005 and observers: mean difference 21.2 days, 95% CI 13.5-28.9; P<.001). The sputum conversion rates in the VOT and DOT groups were 73% and 61.5%, respectively (P=.17). CONCLUSIONS: Smartphone-based VOT significantly outperformed community-based DOT in ensuring compliance with tuberculosis treatment among observers. However, the study was underpowered to confirm improved compliance among patients with pulmonary tuberculosis and to detect differences in sputum conversion rates. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR) TCTR20210624002; https://tinyurl.com/3bc2ycrh. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/38796.

The Effects of Patient Preference on Clinical Outcome, Satisfaction and Adherence Within the Treatment of Anxiety and Depression: A Meta-Analysis.

BACKGROUND: Taking patient preference into consideration has received increased attention in the last decades. We conducted a meta-analysis to estimate the effects of patient preference on clinical outcome, satisfaction and adherence regarding treatment of depression and anxiety. METHODS: Pubmed, Embase, PsycINFO and Scopus were searched for (cluster) randomized controlled trials. Twenty-six randomized controlled clinical trials were included, comprising 3670 participants, examining the effect of patient preference regarding treatment of anxiety and depression on clinical outcome, satisfaction and/or adherence. RESULTS: No effect of patient preference was found on clinical outcome [d = 0.06, 95% CI = (-0.03, 0.15), p = 0.16, n = 23 studies]. A small effect of patient preference was found on treatment satisfaction [d = 0.33, 95% CI = (0.08, 0.59), p = 0.01, n = 6 studies] and on treatment adherence [OR = 1.55, 95% CI = (1.28, 1.87), p < 0.001, n = 22 studies]. LIMITATIONS: Patient preference is a heterogeneous concept, future studies should strive to equalize operationalization of preference. Subgroup analyses within this study should be interpreted with caution because the amount of studies per analysed subgroup was generally low. Most studies included in this meta-analysis focused on patients with depression. The small number of studies (n = 6) on satisfaction, prevents us from drawing firm conclusions. CONCLUSIONS: While this meta-analysis did not find a positive effect of considering patient preference on clinical outcome, it was associated with slightly better treatment satisfaction and adherence. Accommodating preference of patients with anxiety and depression can improve treatment. TRIAL REGISTRATION: PROSPERO: CRD42020172556.

Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review.

Background: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes. Conclusions: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.

Impact of Patient Education Formats on Treatment Adherence and Denture Hygiene in Edentulous Patients: A Comparative Study.

BACKGROUND Effective communication and patient education are important in geriatric dental care. Memory decline complicates patient adherence. This study aimed to compare verbal, audio, and video patient education material (PEM) and adherence to dental prosthetic management in edentulous patients. MATERIAL AND METHODS 90 completely/partially edentulous patients (aged 40 to 70 years), were divided (simple random) into three groups (Gp) of 30 each . A total of 68 instructions were organized into 9 learning categories. For GpVi, a 20 minute video was shot using a Sony camera (PD170), with two actors depicting related PEM information. Patients were recalled after 1 day and 7days, to recall the PEM instructions. A Denture plaque Index (DPI) determined the efficiency of the instructions at both time intervals. Frequencies, means and standard deviations were derived for each group and then compared using Chi square, paired and unpaired t test and a Neuman-Keul post hoc pairwise test. All significant differences were kept at probability t value of ≤0.05. RESULTS PEM instructions related to patient individuality, proper tongue position and miscellaneous showed poor patient recall. At 1 day interval, audio was found to have better recall than video and verbal in 5 PEM instruction categories. At 7 day interval, video showed better recall than other two groups (P≤0.05). Despite improvements in patients recall, DPI revealed better denture hygiene maintenance in patients receiving instructions through video format (P≤0.05). CONCLUSIONS For all categories, no single media was considered to be sufficient, audio produced early better recall while video influenced long term recall and better denture hygiene maintenance.

The relationship between fatigue, pruritus, and thirst distress with quality of life among patients receiving hemodialysis: a mediator model to test concept of treatment adherence.

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

Factors associated with therapeutic non-adherence in renal transplant patients: a bicentric study in Algeria / Facteurs associés à la non-observance thérapeutique chez les patients greffés rénaux : une étude bicentrique en Algérie

Introduction: Medication non-adherence is a global concern, particularly in the context of renal transplantation, where it leads to graft failures, increased hospitalizations, diminished quality of life for patients, and higher healthcare costs. The aim of this study was to assess the level of therapeutic adherence among Algerian kidney transplant recipients and identify potential influencing factors. Methods: A descriptive, cross-sectional bicenter study was conducted among kidney transplant patients receiving outpatient care at two specialized medical centers in Algeria: the Urology Department of the Hospital Establishment for Urology, Nephrology, and Renal Transplantation in Constantine, and the Nephrology and Renal Transplantation Department of the University Hospital Center (CHU) in Blida, spanning from January to December 2022. Therapeutic adherence was assessed using the 8-item Morisky questionnaire, while the level of knowledge was analyzed through a 12-item questionnaire. Logistic regression was used to identify factors associated with non-adherence to therapy. Results: This study included 130 patients with an average age of 47 years and a sex ratio of 1.7. The results revealed therapeutic non-adherence in 40.8% of the patients. Multivariate analysis identified several potentially associated factors, including residence, unemployment status, lack of affiliation with a health insurance fund, the use of a therapeutic regimen involving triple therapy, the occurrence of adverse effects, limited education level, and insufficient disease knowledge. Furthermore, non-adherence was associated with an increased risk of graft rejection. Conclusion: The findings of this study highlight concerning therapeutic adherence among kidney transplant recipients, emphasizing the crucial importance of therapeutic education to improve treatment adherence and underscoring the need to integrate these factors into clinical patient management.

Introduction: La non-observance thérapeutique est un problème mondial préoccupant, notamment dans le contexte de la transplantation rénale où elle entraîne des échecs de greffe, une augmentation des hospitalisations, une détérioration de la qualité de vie des patients et des coûts de santé accrus. Cette étude avait pour objectif d'évaluer le niveau d'observance thérapeutique chez les transplantés rénaux algériens et d'identifier les facteurs qui pourraient l'influencer. Méthodes: Une étude descriptive transversale bicentrique a été menée auprès de patients transplantés rénaux suivis en ambulatoire dans deux centres médicaux spécialisés en Algérie : le service d'urologie de l'Établissement hospitalier spécialisé (EHS) en urologie, néphrologie et transplantation rénale de Constantine ainsi que le service de néphrologie et transplantation rénale du Centre hospitalier universitaire (CHU) de Blida, sur une période allant de janvier à décembre 2022. L'observance thérapeutique a été évaluée à l'aide du questionnaire à 8 items de Morisky, tandis que le niveau de connaissance a été analysé à travers un questionnaire de 12 items. La régression logistique a été utilisée pour identifier les facteurs associés à la non-observance thérapeutique. Résultats: Cette étude a inclus 130 patients présentant un âge moyen de 47 ans et un sex ratio de 1,7. Les résultats ont révélé une non-observance thérapeutique chez 40,8 % des patients. L'analyse multivariée a permis d'identifier plusieurs facteurs potentiellement associés à cette non-observance, notamment le lieu d'habitation, le statut de chômage, l'absence d'affiliation à une caisse d'assurance maladie, l'utilisation d'un schéma thérapeutique incluant une trithérapie, la survenue d'effets indésirables, le niveau d'éducation limité et une connaissance insuffisante de la maladie. En outre, la non-observance a été associée à un risque accru de rejet de greffe. Conclusion: Les résultats de cette étude révèlent une observance thérapeutique préoccupante chez les transplantés rénaux, soulignant l'importance cruciale de l'éducation thérapeutique afin de l'améliorer et mettant en évidence la nécessité d'intégrer ces facteurs dans la gestion clinique des patients.

Treatment Nonadherence among Multimorbid Chronic Disease Patients: Evidence from 3515 Subjects in Indonesia.

Background and Objectives: Multimorbid patients require intensive treatment for their diseases. However, little research has been given to their treatment adherence as part of its management. This study aims to determine the prevalence and characteristics of chronic disease multimorbidity in Indonesia, alongside its treatment nonadherence. Materials and Methods: We conducted a cross-sectional study using the fifth Indonesian Family Life Survey database among adult subjects aged ≥ 15 years with multimorbidity. Our descriptive and multivariate analyses include sex, age, formal education, ethnicity, geographic residence, demographic residence, household size, insurance ownership, annual income, current self-perceived health status, missing active days, smoking behavior, and body mass index. Results: We identified 3515 multimorbid patients, constituting 30.8% prevalence across chronic disease patients. Hypertension was found to be a prevalent component of multimorbidity (61.2%), followed by digestive diseases (44.5%) and arthritis (30.3%). We identified that 36.4% of the subjects were nonadherent to their chronic disease treatment. Characteristics associated with nonadherence were found to be a good self-perception of health (aOR 1.79, 95% CI 1.54-2.08), active smoking behavior (aOR 1.51, 95% CI 1.14-1.99), no smoking behavior (aOR 1.44, 95% CI 1.08-1.90), missing seven active/productive days or less in the past month due to poor health (aOR 1.36, 95% CI 1.10-1.68), no insurance ownership (aOR 1.20, 95% CI 1.04-1.39), age of 15-65 years (aOR 1.25, 95% CI 1.01-1.55), income below IDR 40 million (aOR 1.23, 95% CI 1.04-1.46), and household size of 2-6 people (aOR 1.17, 95% CI 1.01-1.36). Conclusions: While the prevalence of multimorbidity in Indonesia is generally similar to that observed in previous studies, we have identified patient characteristics related to nonadherence. We suggest that patient's nonadherence was primarily dictated by their self-perception of health and treatment complexity. With the longstanding issue of nonadherence, this study indicated the need to consider creating patient-tailored treatment programs in clinical practice to improve adherence by considering individual patients' characteristics.

Exploring Lifestyle Factors and Treatment Adherence among Older Adults with Hypertension Attending a Mobile Health Unit (MHU) in a Rural Area of Central Portugal.

This cross-sectional and analytical study aimed to characterize a sample of hypertensive older adults attending a Mobile Health Unit (MHU) in a rural area of central Portugal according to their lifestyle and to analyze the impact of lifestyles on treatment adherence. The sample comprised 235 Portuguese hypertense patients, mainly females (63.8%) with a mean age of 75 years (±8.14 years) and low level of education. The data collection was carried out through a questionnaire consisting of sociodemographic questions, dietary variables, an Alcohol Dependence Questionnaire, an International Physical Activity Questionnaire (Short Version), a Nutrition Health Determination Questionnaire, a Self-Care with Hypertension Scale, and an Adherence to Treatments Measurement Scale. Only 34.5% of the hypertensive patients have controlled blood pressure values (28.2% men and 38% women). However, more than half (56.2%) of the hypertensive patients are classified as adherent to therapeutic measures. The hypertensive individuals, who present higher levels of adherence to the treatment, do not present alcohol dependence, are frequent consumers of aromatic herbs, sporadically consume salt, present good nutritional health, and practice moderate physical activity. The predictor variables for treatment adherence are the self-care dimensions general dietary (p = 0.001), specific dietary (p = 0.034), physical activity (p = 0.031), and antihypertensive medication intake (p < 0.001). Hypertensive patients with healthier lifestyles present better levels of treatment adherence. Therefore, promoting physical activity and healthy dietary practices is necessary to improve treatment adherence and increase antihypertensive treatment's effectiveness.

Association Between Treatment Adherence and Continuous Glucose Monitoring Outcomes in People With Diabetes Using Smart Insulin Pens in a Real-World Setting.

OBJECTIVE: To evaluate the association of insulin injection adherence, smart insulin pen engagement, and glycemic control using real-world data from 16 countries from adults self-administering basal insulin degludec and bolus insulin with a smart insulin pen (NovoPen 6 or NovoPen Echo Plus) alongside continuous glucose monitoring (CGM). RESEARCH DESIGN AND METHODS: Data were aggregated over 14-day periods. Treatment adherence was defined according to the number of missed basal and missed bolus insulin doses and smart pen engagement according to the number of days with data uploads. RESULTS: Data from 3,945 adults, including 25,157 14-day periods with ≥70% CGM coverage, were analyzed. On average, 0.2 basal and 6.0 bolus insulin doses were missed over 14 days. The estimated probability of missing at least one basal insulin dose over a 14-day period was 17.6% (95% CI 16.5, 18.7). Missing one basal or bolus insulin dose per 14 days was associated with a significant decrease in percentage of time with glucose levels in range (TIR) (3.9-10.0 mmol/L), of -2.8% (95% CI -3.7, -1.8) and -1.7% (-1.8, -1.6), respectively; therefore, missing two basal or four bolus doses would decrease TIR by >5%. Smart pen engagement was associated positively with glycemic outcomes. CONCLUSIONS: This combined analysis of real-world smart pen and CGM data showed that missing two basal or four bolus insulin doses over a 14-day period would be associated with a clinically relevant decrease in TIR. Smart insulin pens provide valuable insights into treatment injection behaviors.

Asthma patients' and physicians' perspectives on the burden and management of asthma: Post-hoc analysis of APPaRENT 1 and 2 to assess predictors of treatment adherence.

INTRODUCTION: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns. METHODS: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence. RESULTS: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting ß2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines. CONCLUSIONS: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.

Association of somatic comorbidity and treatment adherence in patients with psychotic disorder.

BACKGROUND: Increased risk for somatic comorbidity in individuals with schizophrenia has been well established. In addition, psychiatric patients with somatic illnesses are more likely to have more psychiatric readmissions. Increased burden of treatment related to chronic somatic comorbidities may be associated with lower adherence to psychiatric medication. METHODS: Cross-sectional study of 275 patients with schizophrenia spectrum disorder. A general practitioner performed a complete physical health checkup for all participants, including a complete medical examination and laboratory tests. Patients' adherence, attitudes, insight, and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment Scale. Overall symptomatology was measured using the Brief Psychiatric Rating Scale. Regression analysis was used to investigate interactions and associations among health beliefs, disease burden, and treatment adherence. Separate regression models were utilized to account for the complexity of health behavior and treatment adherence pathways. RESULTS: Patients' somatic comorbidity and health behavior were not associated with adherence or attitudes toward antipsychotic treatment. High dose of antipsychotics and obesity were related to the need for medical interventions, while a healthy diet reduced the risk. Higher BPRS score and older age were associated with having somatic symptoms. Somatic comorbidities had no negative effects on treatment adherence or attitudes. CONCLUSION: This study focuses on exploring possible associations between health beliefs and treatment adherence pathways in patients with psychotic disorders. Contrary to our hypotheses, we found no evidence to support our health belief and diseases burden models and their associations.

Diseño de una herramienta para la clasificación de pacientes en base a su actitud farmacoterapéutica / Design of a tool for classifying patients based on their pharmacotherapeutic attitude

Introducción: la percepción y alivio del dolor exhiben variabilidad entre individuos. Edad, género, etnia, nivel educativo, nivel real de estrés, estado de ánimo o las condiciones médicas pueden modificar la interpretación personal del dolor y las respuestas al tratamiento farmacológico. Estas diferencias pueden desempeñar un papel significativo en los efectos, en ocasiones no deseados, del tratamiento analgésico.Objetivos: definir perfiles tipo de pacientes con Síndrome de Espalda Fallida ante actitudes con la enfermedad, el tratamiento, la asistencia sanitaria y el seguimiento que reciben de sus profesionales sanitarios. Crear herramienta para la identificación del perfil de paciente.Material y métodos: estudio de series de casos clínicos, observacional, descriptivo y transversal. Población de estudio: pacientes Unidad Dolor Hospital Universitario Nuestra Señora de La Candelaria (HUNSC) en Tenerife en 3 fases: recopilación datos historia clínica (F0), visita inicial (F1) y entrevista personal (F2).Resultados: se obtienen 5 tipologías de pacientes según las respuestas a 17 ítems. A partir de estas respuestas, se calculan ecuaciones de regresión para predecir el tipo de paciente. Se agrupan en: “Clásicos”, “Dependientes”, “Críticos”, “Inconscientes” y “Responsables”. Por otro lado, se obtienen dos herramientas con 17 ítems y otra con 7 ítems optimizados a fin de simplificar el proceso.Conclusiones: estas herramientas permiten a la Farmacia Comunitaria (FC) identificar a los pacientes en función de sus características con el fin de poder dirigir estrategias personalizadas para cada uno de ellos.(AU)

Quality of life, adherence to voice rehabilitation therapy and psychological variables in patients with head and neck cancer / Calidad de vida, adherencia al tratamiento de rehabilitación de voz y variables psicológicas en pacientes con cáncer de cabeza y cuello

Introduction: Voice problems can affect quality of life (QoL), other psychological aspects, and the adequate adherence to voice rehabilitation therapy. Objective: To determine the association between QoL and treatment adherence (TA) to voice rehabilitation with symptoms of anxiety, depression, and coping strategies. Method: A longitudinal study was conducted with 97 participants with head and neck cancer (H&N) who were attending voice rehabilitation therapy. Instruments: EORTC QLQ-C30 and QLQ-H&N35, Treatment Adherence Checklist, Cancer Coping Questionnaire and HADS. Results: The mean overall QoL was 83.33, and mean TA was 8.80. Lower overall QoL and emotional functioning scores, as well as higher dry mouth scores were associated with higher levels of anxiety. Greater problems with social contact and lower TA were associated to higher depression scores. Conclusion: Consistent with the literature, TA and QoL were associated to depression and QoL was also correlated to anxiety. These results are among the first to explore such aspects in Latino patients and emphasize the importance of multidisciplinary care for H&N cancer patients in voice rehabilitation therapy, given that during their treatment they may encounter psychological barriers that could hinder their progress in voice quality and QoL.(AU)

Introducción: Los problemas de la voz pueden afectar la calidad de vida (CV) y otros aspectos psicológicos, así como la adecuada adherencia a la terapia de rehabilitación de voz. Objetivo: Determinar la relación entre la CV y la adherencia al tratamiento (AT) de rehabilitación de voz con síntomas de ansiedad, depresión y estrategias de afrontamiento. Método: Se realizó un estudio longitudinal en 97 participantes con cáncer de cabeza y cuello (CyC) que asistían a terapia de rehabilitación de voz. Instrumentos: EORTC QLQ-C30 y QLQ-H&N35, Lista de Verificación de Adherencia al Tratamiento, la Escala de Afrontamiento al Cáncer y la HADS. Resultados: La CV global promedio fue de 83.33 y el puntaje promedio de AT fue de 8.80. La calidad de vida global, la función emocional y boca seca se asociaron con la ansiedad. La dimensión de la CV contacto social y la AT tuvieron relación con la depresión. Conclusiones: Consistente con la literatura la AT y la CV tuvieron relación con la depresión y solo la CV se relacionó con la ansiedad. Los resultados presentados son de los primeros en explorar estos aspectos en pacientes latinos y enfatizan la importancia de la atención multidisciplinaria a pacientes con cáncer de CyC en terapia de rehabilitación de voz, dado que en el curso de sus tratamientos pueden encontrar barreras psicológicas que obstaculicen la mejora en la calidad de la voz y la CV.(AU)

Estado nutricional y adherencia a la dieta mediterránea en la población escolar de laciudad de Mataró (Cataluña, España) / Nutritional status and adherence to the Mediterranean diet in the school population of the city of Mataró (Catalonia, Spain)

Introducción: existe una disminución de la adherencia a la dieta mediterránea (DM) y un aumento de la prevalencia del exceso de peso entre la población infantil y juvenil española. Objetivos: el objetivo del presente estudio fue conocer el grado de adherencia a la DM y el estado nutricional de la población escolar de Mataró (España) a fin de obtener información útil para el diseño y aplicación de futuras intervenciones. Material y métodos: se realizó un estudio descriptivo de tipo transversal en una muestra de 1177 escolares de entre 6 y 18 años. Se utilizó el índice KIDMED para evaluar la adherencia a la DM y el índice de masa corporal (IMC) para valorar el estado nutricional. Se incluyeron preguntas relacionadas con la percepción de los estudiantes del acceso a alimentos no saludables, la disponibilidad de dinero y el interés de los padres en recibir educación sobre alimentación. Resultados: el porcentaje de niños y adolescentes con óptima adherencia a la DM no alcanza el 50 %, siendo los jóvenes de secundaria quienes presentan un porcentaje menor (30 %). En relación con el estado nutricional de la muestra, más del 70 % presentaron un estado nutricional normal según el IMC, y un 20,7 % de los alumnos de primaria y un 13,8 % de los de secundaria se clasificaron con exceso de peso. Conclusiones: los datos confirman el interés de diseñar e implementar acciones educativas que involucren tanto a los estudiantes como a los padres, con el objetivo de mejorar los hábitos alimentarios de la población. Los resultados sugieren que la disponibilidad de dinero puede facilitar el acceso a alimentos no saludables y, por consiguiente, se debe considerar la promoción de entornos saludables que aumenten la oferta de alimentos saludables.(AU)

Background: there is a decrease in adherence to the Mediterranean diet (MD) and an increase in the prevalence of excess weight among the Spanish child and adolescent population. Objectives: the objective of the present study was to determine the degree of adherence to MD and the nutritional status of the school population of Mataró (Spain) in order to obtain useful information for the design and application of future interventions. Material and methods: a cross-sectional descriptive study was carried out in a sample of 1177 schoolchildren between 6 and 18 years of age. The KIDMED index was used to assess adherence to MD, and the body mass index (BMI) to assess nutritional status. questions were related to the students' perception of access to unhealthy foods, availability of money and parental interest in receiving nutrition education. Results: the percentage of children and adolescents with optimal adherence to MD does not reach 50 %, with secondary school youths presenting a lower percentage (30 %). Regarding the nutritional status of the sample, more than 70 % had a normal nutritional status according to their BMI, and 20.7 % of primary school students and 13.8 % of secondary school students were classified as overweight. Conclusions: the data confirm the interest of designing and implementing educational actions involving both students and parents, with the aim of improving the eating habits of the population. The results suggest that availability of money may facilitate access to unhealthy foods and, therefore, the promotion of healthy environments that increase the supply of healthy foods should be considered.(AU)

Beyond Therapeutic Adherence: Alternative Pathways for Understanding Medical Treatment in Type 1 Diabetes Mellitus.

Given the psychosocial and economic costs of behaviors of patients who seem not to benefit from the medications, technologies, and medical therapies available for chronic diseases such as Type 1 Diabetes Mellitus, therapeutic adherence has been identified as one of the main focuses in the intervention. This paper presents contributions from semiotic cultural clinical psychology for understanding problems associated with the implementation of medical treatment in patients with Type 1 Diabetes Mellitus to explore psychological dimensions not yet reported in depth. A narrative review of 24 scientific articles published between 2012 and 2023 is carried out. The information is produced through thematic analysis, and the results are presented in three themes: 1. illness characteristics, 2. adherence and associated concepts, and 3. modes of intervention. It concludes with the development of a two-axis proposal for understanding the experience of patients that privileges psychological aspects involved in the disease and its treatment, considering the approach to the goals of treatment as dynamic and fluctuating rather than as final states.

Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática / Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review

El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n=379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan.(AU)

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.(AU)

Antiretroviral adherence and treatment outcomes among patients living with HIV at an Indonesian HIV clinic: a cross-sectional study / Cumplimiento de los antirretrovirales y resultados del tratamiento entre pacientes que viven con el VIH en una clínica de VIH de Indonesia: un estudio transversal

Objective: This study assessed antiretroviral adherence and treatment outcomes among outpatients with human immunodeficiency virus (HIV). Methods: A cross-sectional study was performed on patients with HIV over 18 years old receiving antiretroviral therapy for at least six months at an Indonesian clinic, from January to March 2021. The previously validated self-reported adherence questionnaire was used to recall antiretroviral use. Viral load and CD4 were indicators of treatment outcomes. Binary logistic regression was used to explore factors associated with nonadherence and poor treatment outcomes. Results: Ninety-five patients were included in the study (male 70.5%, median [interquartile range, IQR] age 35 [29–42] years, and median [IQR] treatment duration 29 [15–49] months). Adherence greater than 95% was observed in 89.5%, 88.4%, 95.8% of the patients in the past week, month, and three months, respectively. Patients with secondary education or lower were associated with low adherence (adjusted odds ratio, aOR: 7.73, 95%CI: 1.12– 53.19). Viral suppression and improved CD4 were observed in 83.2% and 68.4% of the patients, respectively. Taking non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based regimen was associated with viral suppression (aOR: 0.01, 95%CI: 0.00–0.14) as well as high CD4 count (aOR: 0.16, 95%CI: 0.03– 0.83). Being diagnosed with stage 4 of HIV (aOR: 72.38, 95%CI: 3.11–1687.28) and having adherence of 95% or lower (aOR: 68.84, 95%CI: 4.86–974.89) were associated with non-suppressed viral load, and having HIV stage 3 (aOR: 7.81, 95%CI: 1.26–48.40) or 4 (aOR: 26.15, 95%CI: 3.42–200.10) at diagnosis was associated with low CD4. Conclusion: Rates of self-reported adherence and treatment outcomes were high. Secondary education or lower was a predictor of low adherence. Using NNRTIs-based therapy was associated with good treatment outcomes; meanwhile, stage 3 or 4 of HIV at diagnosis and low adherence were predictors of poor outcomes. Therefore, strategies to improve adherence and treatment outcomes are warranted.(AU)