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.

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.

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.

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.

Preliminary Impact of Group-Based Interventions on Stigma, Mental Health, and Treatment Adherence Among Adolescents Living with Human Immunodeficiency Virus in Uganda.

OBJECTIVE: To examine the preliminary impact of group cognitive behavioral therapy and multiple family group-based family strengthening to address HIV stigma and improve the mental health functioning of adolescents living with HIV in Uganda. STUDY DESIGN: We analyzed data from the Suubi4Stigma study, a 2-year pilot randomized clinical trial that recruited adolescents living with HIV (10-14 years) and their caregivers (n = 89 dyads), from 9 health clinics. We fitted separate three-level mixed-effects linear regression models to test the effect of the interventions on adolescent outcomes at 3 and 6 months post intervention initiation. RESULTS: The average age was 12.2 years and 56% of participants were females. Participants in the multiple family group-based family strengthening intervention reported lower levels of internalized stigma (mean difference = -0.008, 95% CI = -0.015, -0.001, P = .025) and depressive symptoms at 3 months (mean difference = -0.34, 95% CI = -0.53, -0.14, P < .001), compared with usual care. On the other hand, participants in the group cognitive behavioral therapy intervention reported lower levels of anticipated stigma at 3 months (mean difference = -0.039, 95% CI = -0.072, -0.006), P = .013) and improved self-concept at 6 months follow-up (mean difference = 0.04, 95% CI = 0.01, 0.01, P = .025). CONCLUSION: Outcome trends from this pilot study provide compelling evidence to support testing the efficacy of these group-based interventions on a larger scale. TRIAL REGISTRATION: The study is registered in the Clinical trials.gov database (Identifier #: NCT04528732).

Educação em saúde como estratégia prestada por enfermeiros a pacientes com hipertensão na perspectiva dos cuidados primários / Health education as a strategy provided by nurses to patients with hypertension from the perspective of primary care / La educación sanitaria como estrategia proporcionada por enfermería a pacientes con hipertensión desde la perspectiva de la atención primaria

Objetivo: Descrever a importância do processo de educação em saúde reali- zado pelo enfermeiro aos pacientes hipertensos na atenção básica. Metodologia: Trata-se de uma revisão bibliográfica, onde foram utilizados artigos científicos identificados nas bases de dados: SciELO, LILACS e MEDLINE. Um total de 4.427 estudos foram encon- trados, após o refinamento oito foram selecionados para compor a amostra. Resultados: A estratégia educativa em saúde tem grande efetivação no tratamento da HAS, visto que o enfermeiro vai conhecer o paciente e direcioná-lo ao tratamento adequado, monitorando seu estado de saúde e evitando possíveis agravos. Contudo, o abandono do tratamento pelo cliente é uma das maiores dificuldades enfrentadas pelo o enfermeiro. Além disso, desafios no contexto do processo de trabalho em equipe e barreiras relacionadas à estru- tura física nas unidades de saúde. Considerações finais: O enfermeiro exerce um papel importante dentro do contexto da hipertensão arterial. Trazendo a prática baseada em evi- dências como abordagem, garantindo adesão ao tratamento e o controle dos níveis pres- sóricos da HAS.

Objective: To describe the importance of the health education process carried out by nurses with hypertensive patients in primary care. Methodology: This is a bibliographic review, where scientific articles identified in the databases: SciELO, LILACS and MEDLINE were used. A total of 4,427 studies were found, after refinement, eight were selected to compose the sample. Results: The health education strategy is highly effective in the treatment of SAH, as the nurse will get to know the patient and direct him to the appropriate treatment, monitoring his health status and avoiding possible injuries. However, abandonment of treatment by the client is one of the greatest difficulties faced by the nurse. In addition, challenges in the context of the teamwork process and barriers related to the physical structure in health units. Final considerations: Nurses play an important role within the context of arterial hypertension. Bringing evidence-based practice as an approach, ensuring adherence to treatment and control of blood pressure levels in SAH.

Objetivo: Describir la importancia del proceso de educación para la salud llevado a cabo por enfermeras con pacientes hipertensos en atención primaria. Metodología: Se trata de una revisión bibliográfica, donde los artículos científicos identificados en las bases de datos: SciELO, LILACS y MEDLINE. Fueron encontrados 4.427 estudios, después del refinamiento, ocho fueron seleccionados para componer la muestra. Resultados: La estrategia de educación sanitaria es altamente eficaz en el tratamiento de la HSA, ya que la enfermera conocerá al paciente y lo dirigirá al tratamiento adecuado, monitorizando su estado de salud y evitando posibles lesiones. Sin embargo, el abandono del tratamiento por parte del cliente es una de las mayores dificultades a las que se enfrenta la enfermera. Además, los desafíos en el contexto del proceso de trabajo en equipo y las barreras relacionadas con la estructura física en las unidades de salud. Consideraciones finales: Las enfermeras desempeñan un papel importante en el contexto de la hipertensión arterial. Traer la práctica basada en la evidencia como abordaje, garantizando la adherencia al tratamiento y el control de los niveles de presión arterial en la HTA.

[Adaptation and validation of the MoVac-flu scale on motivation towards the flu vaccine]. / Adaptación y validación de la escala MoVac-flu sobre motivación hacia la vacuna de la gripe.

OBJECTIVE: To translate, adapt and validate the psychometric properties of MoVac-flu scale in order to be used in Spanish. METHOD: The present research was an analytical observational study of cross-cultural adaptation and validation into Spanish of the MoVac-flu scale. It has been carried out between the months of March and July 2022. The sample size was 142 people who were obtained by consecutive sampling. The processes used for the adaptation have been translation, validation by a committee of experts, back-translation and pilot test. For validation, the psychometric properties of reliability, internal consistency, appearance validity, content validity, utility and ceiling-floor effect have been verified. RESULTS: The internal consistency of the MoVac-flu scale in its version translated into Spanish was high, showing a McDonald's ω of 0.914. CONCLUSIONS: The MoVac-flu scale in Spanish allows to measure the degree of motivation towards vaccination against influenza in the adult population.

"If I don't take my treatment, I will die and who will take care of my child?": An investigation into an inclusive community-led approach to addressing the barriers to HIV treatment adherence by postpartum women living with HIV.

INTRODUCTION: Initiatives to support adherence to HIV treatment in South Africa are often centred on service delivery thereby avoiding key challenges to adherence: stigma and poverty. In contrast, this study aims to demonstrate the strength of an inclusive research and programme approach to improving the lives of people living with HIV and simultaneously ARV adherence. METHODS: Participatory Action Research combined with a visual participatory method (Photovoice) was used by postpartum women to share their experience of taking ARVs. The research was analysed from an interpretative and critical paradigm where both the women and a non-governmental organisation collaborated in the data collection, analysis and interpretation of the findings. Together, they then disseminated the findings and used a community-led approach to create a programme addressing these barriers effectively. FINDINGS: Two main barriers to ARV adherence emerged: the anticipated stigma associated with issues of disclosure and poverty epitomized by alcohol abuse, gender-based violence and hunger. The women and the NGO staff successfully presented their findings at conferences and collaborated to develop a programme of support for all women living with HIV in the area. The programme addresses each of the issues raised by the co-researchers and is run via a community-led process where the participants lead on design, implementation, and monitoring and ultimately will revise the programme as needed. DISCUSSION: The inclusive approach of this study enabled these postpartum women to portray the intersectional nature of both HIV stigma and poverty that affects their lives. By working with the local NGO to develop a programme based on these insights, they were able to tailor specific interventions to the issues women living with HIV face in their area. In doing so, they aim to improve the lives of people living with HIV by demonstrating a more sustainable way to impact ARV adherence. CONCLUSION: Currently, health service insistence on measuring ARV adherence does not address the core barriers to taking ARVs and misses the opportunity to focus on the long term health and well-being of people living with HIV. In contrast, locally targeted participatory research and programme development based on inclusivity, collaboration and ownership do address the fundamental challenges of people living with HIV. In doing so, it can have a greater impact on their long term well-being.

Adenocarcinoma cervical e abandono terapêutico: a ótica dos enfermeiros em uma cidade do extremo norte brasileiro / Cervical adenocarcinoma and therapeutic dropouts: the perspective of nurses in a city in the extreme north of brazil / Adenocarcinoma cervical y abandono terapéutico: la perspectiva de los enfermeros de una ciudad del extremo norte de brasil

RESUMO Objetivo: descrever, na perspectiva do enfermeiro, as causas de abandono das usuárias em tratamento do adenocarcinoma cervical e analisar as propostas para diminuir esse abandono. Método: o estudo é descritivo, qualitativo, do tipo investigação narrativa. Participaram sete enfermeiros assistencialistas, atuantes em uma unidade de alta complexidade oncológica, na cidade de Macapá, capital do estado do Amapá, Brasil. O estudo foi realizado no período de três a 20 de dezembro de 2019. Os dados foram submetidos à análise temática categorial. Resultados: emergiram duas categorias: principais causas de abandono das usuárias em tratamento do adenocarcinoma cervical e estratégias do enfermeiro para a diminuição do abandono do tratamento pelas usuárias. Conclusão: para favorecer o resgate das usuárias, os enfermeiros participantes propõem consulta de Enfermagem e um plano de ação multiprofissional, respeitando as singularidades de cada mulher.

ABSTRACT Objective: to describe, from the perspective of nurses, the causes of dropout of users in treatment for cervical adenocarcinoma and analyze the proposals to reduce this dropout. Method: the study is descriptive, qualitative, of narrative research type. Seven care nurses, working in a high complexity oncology unit in the city of Macapá, capital of the state of Amapá, Brazil, participated. The study was conducted in the period from December three to 20, 2019. Data were submitted to categorical thematic analysis. Results: two categories emerged: main causes of dropout of users in treatment for cervical adenocarcinoma and nurse strategies for the reduction of treatment dropout by users. Conclusion: to promote the rescue of the users, the participating nurses propose a Nursing consultation and a multi-professional action plan, respecting the singularities of each woman.

RESUMEN Objetivo: describir, desde el punto de vista del enfermero, las causas de abandono de las usuarias en el tratamiento del adenocarcinoma de cuello uterino y analizar las propuestas para disminuir dicho abandono. Método: El estudio es una investigación descriptiva, cualitativa y narrativa. Participaron siete enfermeros asistenciales, que trabajan en una unidad de oncología de alta complejidad en la ciudad de Macapá, capital del estado de Amapá, Brasil. El estudio se realizó en el periodo comprendido entre el 3 y el 20 de diciembre de 2019. Los datos se sometieron a un análisis categórico temático. Resultados: surgieron dos categorías: principales causas de abandono de las usuarias en el tratamiento del adenocarcinoma cervical y estrategias de los enfermeros para reducir el abandono del tratamiento por parte de las usuarias. Conclusión: para favorecer el resguardo de las usuarias, los enfermeros participantes proponen una consulta de Enfermería y un plan de acción multiprofesional, resaltando las singularidades de cada mujer.

Association of Antidepressant Prescription Filling With Treatment Indication and Prior Prescription Filling Behaviors and Medication Experiences.

BACKGROUND: Given the wide range of uses for antidepressants, understanding indication-specific patterns of prescription filling for antidepressants provide valuable insights into how patients use these medications in real-world settings. OBJECTIVE: The objective of this study was to determine the association of antidepressant prescription filling with treatment indication, as well as prior prescription filling behaviors and medication experiences. DESIGN: This retrospective cohort study took place in Quebec, Canada. PARTICIPANTS: Adults with public drug insurance prescribed antidepressants using MOXXI (Medical Office of the XXIst Century)-an electronic prescribing system requiring primary care physicians to document treatment indications and reasons for prescription stops or changes. MEASURES: MOXXI provided information on treatment indications, past prescriptions, and prior medication experiences (treatment ineffectiveness and adverse drug reactions). Linked claims data provided information on dispensed medications and other patient-related factors. Multivariable logistic regression models estimated the independent association of not filling an antidepressant prescription (within 90 d) with treatment indication and patients' prior prescription filling behaviors and medication experiences. RESULTS: Among 38,751 prescriptions, the prevalence of unfilled prescriptions for new and ongoing antidepressant therapy was 34.2% and 4.1%, respectively. Compared with depression, odds of not filling an antidepressant prescription varied from 0.74 to 1.57 by indication and therapy status. The odds of not filling an antidepressant prescription was higher among adults filling < 50% of their medication prescriptions in the past year and adults with an antidepressant prescription stopped or changed in the past year due to treatment ineffectiveness. CONCLUSION: Antidepressant prescription filling behaviors differed by treatment indication and were lower among patients with a history of poor prescription filling or ineffective treatment with antidepressants.

Efecto del uso de mensajes de texto en dispositivos de telefonía móvil en la adherencia al tratamiento de hipertensión arterial / Effect of mobile phone text messaging on adherence to hypertension treatment

La hipertensión arterial es una de las enfermedades crónicas de mayor incidencia a nivel mundial, produce una importante mortalidad y discapacidad. Este trabajo tuvo por objetivo evaluar el efecto del uso de mensajes de texto en dispositivos de telefonía móvil en la adherencia al tratamiento de hipertensión arterial. Se efectuó un estudio de intervención cuasiexperimental, de antes y después, en el cual se entrevistó a pacientes que pertenecían a un programa ambulatorio de enfermedades crónicas. Se formaron 4 grupos, uno de ellos, el grupo control. A los grupos intervenidos se les remitieron mensajes de texto (educativos/motivadores), con diferentes frecuencias de envío, por un período de 2 meses. Al término de la intervención, se pidió llenar el cuestionario Martín-Bayarre-Grau para determinar su adherencia al tratamiento antihipertensivo antes y después de la intervención. Se realizó un análisis bivariado, en el cual se comparó la variable adherencia al tratamiento, antes y después de la intervención, de los cuatro grupos del estudio. Se encontró solo una diferencia significativa en el grupo 3 (p = 0,011), al cual se le enviaron 8 mensajes al mes (2 por semana). También se comparó, después de los 2 meses, a los grupos sometidos a intervención versus el grupo control; se halló una diferencia significativa en el grupo 3 (p = 0,022). La intervención ha demostrado ser útil para mejorar la adherencia en esta población de estudio. Se obtuvo una respuesta positiva en el grupo 3, que recibió 8 mensajes al mes(AU)

Hypertension is one of the chronic diseases with the highest incidence worldwide and a cause of considerable mortality and disability. This paper aims to evaluate the effect of mobile phone text messaging on adherence to hypertension treatment. A quasi-experimental before-after intervention was conducted based on interviews with patients from a chronic disease outpatient program. Four groups were formed, one of which was the control group. The groups intervened were sent encouraging educational text messages at varying frequencies for a period of two months. At the close of the intervention, participants were asked to fill in the Martín Bayarre Grau questionnaire to determine their adherence to antihypertensive treatment before and after the intervention. A bivariate analysis was performed comparing the variable adherence to treatment before and after the intervention in the four study groups. A significant difference was only found in Group 3 (p = 0.011). This group was sent eight messages per month (two messages per week). Additionally, a comparison between the intervention groups and the control group conducted at two months found a significant difference in Group 3 (p = 0.022). The intervention proved was useful to improve adherence in the study population. A positive response was obtained in Group 3, who received eight messages per month(AU)

Knowledge about the disease and adherence to treatment in patients with diabetes

Introduction: Glycemic decompensation in diabetes is one of the major factors for the development of chronic disease complications. Factors involved in the adequate control of diabetes include adherence to pharmacological treatment and knowledge about the disease.Methods: Cross-sectional study on the factors associated with adherence to drug treatment and knowledge about diabetes in diabetic patients treated at Hospital Universitário de Santa Maria between 2018 and 2019, based on the validated Morisky-Green test and on the Diabetes Knowledge Questionnaire.Results: A total of 201 patients diagnosed with diabetes were included, the majority (85.6%) of which had type 2 diabetes and were white (75.6%), with a mean age of 59.4 years. An association between insufficient knowledge about diabetes and patients with type 2 diabetes was observed. An association was found between patients with type 2 diabetes using insulin and non-adherence to drug treatment compared with patients with type 2 diabetes who did use insulin. The research also showed that non-adherence to drug treatment was associated with higher occurrence of hypoglycemia compared with patients who adhered to drug treatment.Conclusion: The data obtained in our study allows us to conclude that non-adherence to pharmacological treatment makes diabetes therapy more complicated and worsens the prognosis.

A influência dos aspectos subjetivos na adesão ao tratamento do transtorno bipolar: uma revisão sistemática / The influence of subjective aspects on adherence to the treatment of bipolar disorder: a systematic review

OBJETIVO: Evidenciar a influência dos aspectos subjetivos na adesão ao tratamento do transtorno bipolar. MÉTODOS: Foi realizada revisão sistemática com base nas diretrizes PRISMA. A identificação dos estudos foi realizada por meio da busca nos bancos de dados PubMed, Scopus e SciELO, com base nos descritores "Bipolar Disorder" AND "Treatment Adherence and Compliance" AND "Mental Health". A busca contemplou todos os artigos publicados até o ano 2020, sem restrição de idioma. RESULTADOS: Foram localizados 743 artigos, 714 foram excluídos no processo de seleção, 29 foram lidos na íntegra e 11 foram elegíveis para a composição da amostra. A influência dos aspectos subjetivos na adesão ao tratamento foi associada (1) às atitudes resultantes das percepções do sujeito sobre o transtorno e o tratamento e (2) as atitudes por influência de pessoas próximas. Os estudos apontam para a ocorrência de atitudes negativas em ambas as esferas, tendo a má adesão ao tratamento como desfecho. Na esfera da percepção do sujeito, evidenciam-se: presença de comportamentos intencionais e não intencionais; percepção de consequências; medo dos efeitos colaterais; sentimentos negativos; falta de compreensão sobre o transtorno e negação do diagnóstico. Na esfera da influência das pessoas próximas, destacam-se a baixa qualidade da aliança terapêutica e o suporte ineficaz oferecido pela família. CONCLUSÕES: Para melhorar a adesão ao tratamento do transtorno bipolar, é salutar que os esforços terapêuticos estejam centrados na experiência particular do sujeito, na sua satisfação e na colaboração pactuada com o tratamento.

OBJECTIVE: Evidence the influence of subjective aspects on adherence to the treatment of bipolar disorder. METHODS: A systematic review was performed based on the PRISMA guidelines. The identification of studies was performed by searching the PubMed, Scopus and Scielo databases based on the descriptors "Bipolar Disorder" AND "Treatment Adherence and Compliance" AND "Mental Health". The selection included all articles published up to the year 2020 and without language restrictions. RESULTS: A total of 743 articles were found, 714 were excluded from the selection process, 29 articles were read in full and 11 were eligible for sample composition. The influence of subjective aspects on treatment adherence was associated (1) with attitudes resulting from the subject's perceptions about the disorder and treatment and (2) attitudes influenced by people close to them. Studies point to the occurrence of negative attitudes in both spheres, with poor adherence to treatment as an outcome. In the sphere of the subject's perception, they show the presence of intentional and unintentional behaviors; perception of consequences; fear of side effects; negative feelings; lack of understanding about the disorder and denial of diagnosis. In the sphere of influence of those close to them, they highlight the low quality of the therapeutic alliance and the ineffective support offered by the family. CONCLUSIONS: To improve adherence to treatment for bipolar disorder, it is beneficial that therapeutic efforts are centered on the individual's particular experience, on their satisfaction and on the agreed collaboration with the treatment.

Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta-analysis.

INTRODUCTION: Adolescents and young people comprise a growing proportion of new HIV infections globally, yet current approaches do not effectively engage this group, and adolescent HIV-related outcomes are the poorest among all age groups. Providing psychosocial interventions incorporating psychological, social, and/or behavioural approaches offer a potential pathway to improve engagement in care and health and behavioural outcomes among adolescents and young people living with HIV (AYPLHIV). METHODS: A systematic search of all peer-reviewed papers published between January 2000 and July 2020 was conducted through four electronic databases (Cochrane Library, PsycINFO, PubMed and Scopus). We included randomized controlled trials evaluating psychosocial interventions aimed at improving engagement in care and health and behavioural outcomes of AYPLHIV aged 10 to 24 years. RESULTS AND DISCUSSION: Thirty relevant studies were identified. Studies took place in the United States (n = 18, 60%), sub-Saharan Africa (Nigeria, South Africa, Uganda, Zambia, Zimbabwe) and Southeast Asia (Thailand). Outcomes of interest included adherence to antiretroviral therapy (ART), ART knowledge, viral load data, sexual risk behaviours, sexual risk knowledge, retention in care and linkage to care. Overall, psychosocial interventions for AYPLHIV showed important, small-to-moderate effects on adherence to ART (SMD = 0.3907, 95% CI: 0.1059 to 0.6754, 21 studies, n = 2647) and viral load (SMD = -0.2607, 95% CI -04518 to -0.0696, 12 studies, n = 1566). The psychosocial interventions reviewed did not demonstrate significant impacts on retention in care (n = 8), sexual risk behaviours and knowledge (n = 13), viral suppression (n = 4), undetectable viral load (n = 5) or linkage to care (n = 1) among AYPLHIV. No studies measured transition to adult services. Effective interventions employed various approaches, including digital and lay health worker delivery, which hold promise for scaling interventions in the context of COVID-19. CONCLUSIONS: This review highlights the potential of psychosocial interventions in improving health outcomes in AYPLHIV. However, more research needs to be conducted on interventions that can effectively reduce sexual risk behaviours of AYPLHIV, as well as those that can strengthen engagement in care. Further investment is needed to ensure that these interventions are cost-effective, sustainable and resilient in the face of resource constraints and global challenges such as the COVID-19 pandemic.

[Treatment of refractory epilepsy. A comparison between classic ketogenic diet and modified Atkins diet in terms of efficacy, adherence, and undesirable effects]. / Tratamiento de la epilepsia refractaria. Comparación entre la dieta cetogénica clásica y la de Atkins modificada en cuanto a eficacia, adherencia y efectos indeseables.

INTRODUCTION: Background: the ketogenic diet (CD) is an established, effective non-pharmacological treatment for refractory epilepsy in childhood. Aim: the objective of this study was to compare the efficacy, the presence of undesirable effects, and adherence between the classic ketogenic diet (DCC) and the modified Atkins diet (DAM). Materials and methods: a retrospective and comparative investigation was carried out to evaluate the medical records of all the patients who started treatment with a ketogenic diet by the same team between 2008 and 2018. In all, 57 patients were started on a DAM diet and 19 patients were given a DCC diet. Results: it was observed that both the Atkins and the classic diets were equally effective (approximately, 80 %; p = 0.252). Regarding adherence, there was a significantly higher percentage of adherence to the Atkins diet than to the classic diet (p = 0.018). Fewer adverse effects were observed with DAM than with DCC (p = 0.012). In all, 21 % of patients under DAM had unfavorable effects (12/57), while 52.63 % of patients on DCC had complications (10/19). Conclusion: a comparable effectiveness in terms of crisis control was found between DAM and DCC. However, DAM exhibits a much better adherence than DCC, and its undesirable effects are milder, less common. That is why, according to other works, it is likely that DAM should be first-choice for patients with refractory epilepsy in a large percentage of cases.

INTRODUCCIÓN: Introducción: la dieta cetogénica (CD) es un tratamiento no farmacológico efectivo, ya establecido para la epilepsia refractaria en la infancia. Objetivo: el objetivo de este estudio fue comparar la eficacia, la presencia de efectos indeseables y la adherencia entre la dieta cetogénica clásica (DCC) y la dieta de Atkins modificada (DAM). Materiales y métodos: se realizó una investigación retrospectiva y comparativa, evaluando las historias clínicas de todos los pacientes que iniciaron tratamiento con dieta cetogénica a cargo de un mismo equipo de trabajo entre 2008 y 2018. Se incluyeron 57 pacientes que iniciaron una dieta DAM y 19 pacientes con dieta DCC. Resultados: se observó que tanto la dieta Atkins como la clásica fueron igualmente eficaces (80 %, aproximadamente; p = 0,252). En relación a la adherencia, se registró un porcentaje significativamente mayor de adherencia a la dieta Atkins que a la clásica (p = 0,018). Se observaron menos efectos adversos con la DAM que con la dieta CC (p = 0,012). El 21 % de los pacientes con DAM presentaron efectos desfavorables (12/57), mientras que el 52.63 % de los pacientes en DCC tuvieron complicaciones (10/19). Conclusión: se describe una efectividad equiparable en cuanto al control de crisis entre la DAM y la DCC. Sin embargo, la DAM presenta una adherencia mucho mejor que la observada con la DCC y sus efectos indeseables son más leves y más infrecuentes. Es por eso que, de acuerdo con otros trabajos, la DAM probablemente sea la primera elección para los pacientes con epilepsia refractaria en un gran porcentaje de los casos.

National systemic lupus erythematosus prospective cohort in Saudi Arabia: A study protocol.

ABSTRACT: Systemic Lupus erythematosus (SLE) is a chronic multisystem, multifactorial inflammatory autoimmune disease. The SLE patients have 3 times increased risk of mortality based on international data with ethnicity playing an important impact on patients' morbidity and mortality. Descriptive studies from Saudi Arabia showed variation in clinical features from one region to another. Moreover, reliable inference from these studies is limited by study methodology and lack of translational data using biological samples to understand clinical phenotypes of Saudi SLE patients.The aim of this report is to describe the prospective study protocol of the National Systemic Lupus Erythematosus Cohort in Saudi Arabia. The purpose of this cohort study is multifold: first, to examine clinical characteristics and molecular phenotypes of Saudi SLE patients in relation to local environment and practices/lifestyles; second, to assess long-term outcomes of SLE in Saudi population and factors that influence favorable outcomes; third, to compare the effectiveness of various treatment regimens in Saudi SLE population.This study is a longitudinal prospective cohort study of adult, Saudi SLE patients using open cohort study design. Primary outcomes include disease-related outcomes (activity, improvement, and organ damage) and patient-reported outcomes (quality of life). Secondary outcomes include physiological and molecular modifications associated with changes in disease activity states.Results and analysis are in on-going study.This study provides a source of reliable data for clinical and translational research. This will allow us to have a holistic approach to SLE pathogenesis especially in Saudi population and may take us a step further toward much more personalized medicine.This protocol has been registered in NIH ClinicalTrial.gov (ClinicalTrial.gov identifier: NCT04604990) on October 27, 2020.

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Abstract Background Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension. Objective To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control. Methods Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student's t test. Significance was accepted at p<0.05. Results Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026). Conclusion Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019.

Importance: Lung cancer screening (LCS) can reduce lung cancer mortality with close follow-up and adherence to management recommendations. Little is known about factors associated with adherence to LCS in real-world practice, with data limited to case series from selected LCS programs. Objective: To analyze adherence to follow-up based on standardized follow-up recommendations in a national cohort and to identify factors associated with delayed or absent follow-up. Design, Setting, and Participants: This retrospective cohort study was conducted in Veterans Health Administration (VHA) facilities across the US. Veterans were screened for lung cancer between 2015 to 2019 with sufficient follow-up time to receive recommended evaluation. Patient- and facility-level logistic regression analyses were performed. Data were analyzed from November 26, 2019, to December 16, 2020. Main Outcomes and Measures: Receipt of the recommended next step after initial LCS according to Lung CT Screening Reporting & Data System (Lung-RADS) category, as captured in VHA or Medicare claims. Results: Of 28 294 veterans (26 835 [94.8%] men; 21 969 individuals [77.6%] were White; mean [SD] age, 65.2 [5.5] years) who had an initial LCS examination, 17 863 veterans (63.1%) underwent recommended follow-up within the expected timeframe, whereas 3696 veterans (13.1%) underwent late evaluation, and 4439 veterans (15.7%) had no apparent evaluation. Facility-level differences were associated with 9.2% of the observed variation in rates of late or absent evaluation. In multivariable-adjusted models, Black veterans (odds ratio [OR], 1.19 [95% CI, 1.10-1.29]), veterans with posttraumatic stress disorder (OR, 1.13 [95% CI, 1.03-1.23]), veterans with substance use disorders (OR, 1.11 [95% CI, 1.01-1.22]), veterans with lower income (OR, 0.88 [95% CI, 0.79-0.98]), and those living at a greater distance from a VHA facility (OR, 1.06 [95% CI, 1.02-1.10]) were more likely to experience delayed or no follow-up; veterans with higher risk findings (Lung-RADS category 4 vs Lung-RADS category 1: OR, 0.35 [95% CI, 0.28-0.43]) and those screened in high LCS volume facilities (OR, 0.38 [95% CI, 0.21-0.67]) or academic facilities (OR, 0.86 [95% CI, 0.80-0.92]) were less likely to experience delayed or no follow-up. In sensitivity analyses, varying how stringently adherence was defined, expected evaluation ranged from 14 486 veterans (49.7%) under stringent definitions to 20 578 veterans (78.8%) under liberal definitions. Conclusions and Relevance: In this cohort study that captured follow-up care from the integrated VHA health care system and Medicare, less than two-thirds of patients received timely recommended follow-up after initial LCS, with higher risk of delayed or absent follow-up among marginalized populations, such as Black individuals, individuals with mental health disorders, and individuals with low income, that have long experienced disparities in lung cancer outcomes. Future work should focus on identifying facilities that promote high adherence and disseminating successful strategies to promote equity in LCS among marginalized populations.

Patient-Centered Education in Wound Management: Improving Outcomes and Adherence.

GENERAL PURPOSE: To educate wound care practitioners about methods of communication that can help promote patient adherence to wound healing recommendations. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Distinguish the use of theoretical frameworks to promote patient adherence to prescribed wound healing recommendations.2. Synthesize the principles of motivational interviewing to best encourage patients to adhere to prescribed wound healing recommendations.3. Select the appropriate self-care strategies for patients who have nonhealing wounds.

Patients with chronic wounds make daily decisions that affect healing and treatment outcomes. Patient-centered education for effective self-management decreases episodes of care and reduces health expenditures while promoting independence. Theoretical frameworks, including the Health Belief Model, Theory of Planned Behavior, Social Cognitive Theory, and Transtheoretical Model of Behavior Change, can assist healthcare providers in identifying strategies that enhance adherence. These strategies include the use of motivational interviewing, a communication technique designed to elicit patients' perspectives regarding treatment goals, outcome expectations, anticipated barriers, and intentions to follow provider recommendations.