RESUMO
BACKGROUND: In patients with hypertension noncompliance with drug treatment is between 15 to 54%, and has been recognised as a relevant contributor to the burden of cardiovascular morbidity. Up to 92% of patients experience unpleasant symptoms with their condition and, particularly in these patients, the symptoms experienced may enhance compliance. OBJECTIVE: To simultaneously assess the effects of physical, social and psychological factors on noncompliance. METHODS: Patients with mild hypertension despite drug treatment, from the departments of cardiology and internal medicine, were requested to answer a self-administered questionnaire addressing the presence of physical symptoms as well as psychosocial factors. The questionnaire was based on previously used test batteries and consisted of two lists of physical complaints and four lists addressing the four domains of planned behaviour regarding medical non-adherence according to Baron and Byrne. These domains mainly assess psychosocial factors. Each list consisted of three or more items and each item was scored on fiveto seven-point scales. Mean scores were used for assessment. The lists were also separately assessed for internal consistency and reliability using Cronbach's alphas. One-way analysis of variance and multivariate analysis of variance (MANOVA) with compliance as outcome variable and the physical, social and psychological variables as indicator variables were used for data analysis. MANOVA was adjusted for multiple testing. RESULTS: Many patients experienced physical symptoms due to hypertension, such as tiredness (31%), hot flushes (28%), headache (24%), reduced daily life energy (23%), palpitations (22%), with 95% confidence intervals between 16 to 38%. Scores for physical symptoms and social factors did not differ between self-reported adherers (n=165) and nonadherers (n=11). However, the score for psychological factors was significantly larger in the adherers than in the non-adherers, 5.05 versus 3.06, p<0.018. The MANOVA showed a significant overall difference between the adherers and non-adherers in the data at p<0.012, which was mainly due to the score for psychological factors. Conclusion. The effect of physical symptoms on non-compliance in mildly hypertensive patients is negligible. So is the effect of social factors. Psychological factors such as lacking a sense of guilt, regret and shame are major determinants of non-compliance. Physicians may play an educational role in improving their patients' compliance by addressing these determinants. We should add that the conclusions should be made with reservations, given the small number of non-adherers in our sample. (Neth Heart J 2008;16:197-200.).
RESUMO
A class of amphiphilic macromolecules has been synthesized by combining well-defined polystyrene (PS) with poly(propylene imine) dendrimers. Five different generations, from PS-dendr-NH(2) up to PS-dendr-(NH(2))(32), were prepared in yields of 70 to 90 percent. Dynamic light scattering, conductivity measurements, and transmission electron microscopy show that in aqueous phases, PS-dendr-(NH(2))(32) forms spherical micelles, PS-dendr-(NH(2))(16) forms micellar rods, and PS-dendr-(NH(2))(8) forms vesicular structures. The lower generations of this class of macromolecules show inverted micellar behavior. The observed effect of amphiphile geometry on aggregation behavior is in qualitative agreement with the theory of Israelachvili et al. The amphiphiles presented here are similar in shape but different in size as compared with traditional surfactants, whereas they are similar in size but different in shape as compared with traditional block copolymers.
RESUMO
Vascular injuries of the popliteal or crural arteries complicating tibial fractures are rare. They often lead to acute critical limb ischaemia requiring immediate invasive diagnostic procedures and surgical repair. To illuminate the acute situation of this combined injury two case histories are presented. A comprehensive surgical approach is mandatory to salvage the injured limb.