Factores cognitivos predictivos de adherencia terapéutica en personas con sobrepeso y obesidad / Cognitive factors predicting therapeutic adherence in people with overweight and obesity

Resumen La falta de adherencia al tratamiento (ADT) en personas con enfermedades crónicas puede fluctuar entre 40 y 75%. Dos tercios de los pacientes con obesidad bajo tratamiento recuperan el peso perdido tras un año, y casi todos a los cinco años, lo que se asocia con la falta de ADT. Esta refiere a un fenómeno multidimensional que supone la acción recíproca de diversos factores, y entre ellos los relativos al paciente. Supuesto que dio paso al surgimiento de los modelos socio-cognitivos de la ADT. El objetivo del presente trabajo fue identificar qué factores de tres diferentes modelos (Teoría de la conducta planeada [TCP], Creencias en salud y el de Wallston) pueden predecir la ADT de pacientes con sobrepeso u obesidad. Participaron 118 adultos, con edad promedio de 52.0 años (DE = 19.0), quienes estaban bajo tratamiento farmacológico y completaron tres cuestionarios, cada uno relativo a los modelos evaluados, y otro más referente a ADT. De los 13 factores, solo uno (Actitudes, del modelo de TCP) mostró capacidad para predecir la ADT (t = 2.75, ß = .26, p < .01). Por tanto, en el caso del sobrepeso u obesidad resulta necesario proponer modelos que reflejen mejor los aspectos que subyacen a la ADT.

Abstract The lack of adherence to treatment (ADT) in people with chronic diseases range from 40 to 75%. Two thirds of the patients with obesity under treatment recover the weight lost after one year, and almost all of them after five years, which is associated with the lack of ADT. Adherence refers to a multidimensional phenomenon that involves the reciprocal action of several factors, including those related to the patient. Assumption that triggered the first socio-cognitive models of ADT. The aim of the present work was to identify which factors of three different models (Theory of the planned behavior [TPB], Beliefs in health, and the one of Wallston) can predict the ADT of patients with overweight or obesity. A total of 118 adults participated, with an average age of 52.0 years (SD = 19.0), who were under pharmacological treatment and completed three questionnaires, each one related to the models evaluated, and another one related to ADT. Of the 13 factors, only one (attitudes, from the TPB model) showed ability to predict ADT (t = 2.75, ß = .26, p < .01). Therefore, for overweight and obesity it is necessary to propose models that can reflect better the differences that underlie the ADT.

Sobrecarga y autoeficacia percibida en cuidadores primarios informales de pacientes con insuficiencia cardíaca / Burden and perceived Self-efficacy in informal primary caregivers of patients with heart failure

Objetivo. Examinar la asociación entre autoeficacia y sobrecarga percibida del cuidador de pacientes con insuficiencia cardíaca. Diseño. Estudio exploratorio y correlacional de corte transversal. Emplazamiento. Ámbito comunitario. Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas'. Participantes. 109 cuidadores de pacientes con insuficiencia cardíaca. Mediciones Principales. Se realizó una evaluación psicológica, en la que se aplicaron los siguientes instrumentos: Escala de Carga Zarit y la Escala de Autoeficacia Percibida en Cuidadores Primarios Informales de Enfermos Crónicos. Resultados. El 49,5% (95%IC: 82,12-89,16) de la muestra reportó un nivel de autoeficacia bajo. El 27,5% (95%IC: 20,04-22,75) presentó sobrecarga leve y el 25,7% (95%IC: 37,71-47,78) sobrecarga intensa. Los resultados del análisis revelan una relación inversamente proporcional entre las variables del estudio (rs=-0,592, p<0,05), Eliminar lo siguiente: esto quiere decir que a mayor sobrecarga menor autoeficacia percibida y viceversa. Conclusiones. La sobrecarga es una de las consecuencias negativas más reportadas. Al estar relacionada con la autoeficacia percibida, este hallazgo podría ser considerado en el diseño de programas de intervención para reducir la carga del cuidador (AU)

Objective. To examine the association between perceived self-efficacy and burden in caregivers of patients with heart failure. Design. Cross-sectional exploratoy and correlational study. Location. Community level. Instituto Nacional de Enfermedades Respiratorias (National Institute of Respiratory Diseases) 'Ismael Cosío Villegas'. Participants. 109 caregivers of patients with heart failure. Main measures. A psychological evaluation was performed in which the following instruments were applied: the Zarit Burden Scale and Scale of Perceived Self-Efficacy in Informal Primary Caregivers of the Chronically Sick. Results. 49.5% (95% CI: 82.12-89.16) of the sample reported a low level of self-efficacy. 27.5% (95% CI: 20.04-22.75) had low burden and 25.7% (95% CI: 37.71-47.78) intense burden. The results of the analysis revealed an inverse relationship between the study variables (r = -0.592), so that the higher the perceived self-efficacy the lower the burden, and viceversa. Conclusions. The burden is one of the most commonly reported negative consequences. Since it is related to the perceived self-efficacy, this finding could be taken into account when designing intervention programs that reduce caregiver burden (AU)

Association of cardiac cachexia and atrial fibrillation in heart failure patients.

BACKGROUND: Cachexia is a common complication in patients with advanced heart failure (HF) associated with inflammatory response activation. Atrial fibrillation (AF) is the most frequent arrhythmia (26%), probably both exacerbate the cardiac cachexia (CC). OBJECTIVES: Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure patients. MATERIAL AND METHODS: In a case control study, CC was diagnosed by electrical bioimpedance with vectorial analysis (BIVA). Subjects with congenital heart disease, cancer, HIV, drug use and other causes than HF were excluded. RESULTS: Of the 359 subjects analyzed (men: 52.9%) median age 65years (55-74). Those with CC were older [72 (61-67)] vs. without [62 (52-70) years old, p<0.01]. During follow-up 47.8% of subjects developed CC and 17.27% AF, this was significantly more frequent in cachectic patients CC (23% vs 12.11%, OR: 2.17, 95% CI: 1.19-4.01, p=0.006). Subjects, with AF had lower left ventricular ejection fraction (25.49±12.96 vs. 32.01±15.02, p=0.08), lower posterior wall thickness (10.03±2.12 vs. 11.00±2.47, p=0.007), larger diameter of the left atrium (49.87±9.84 vs. 42.66±7.56, p<0.001), and a higher prevalence of CC (85.42% vs. 69.77%, p=0.028). The 50.58% of was in NYHA class I. In NYHA III, 22.95% were in AF vs. 12.10% with not AF (p=0.027). CONCLUSION: The frequent coexistence of CC and AF as HF complications indicate greater severity of HF, regardless of its type of HF.