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.

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.

HIV-Related Stigma and Treatment Adherence Among Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Meth in the Metropolitan Area of Mexico City.

Internationally, HIV-related stigma and crystal methamphetamine (meth) use have been described as barriers to treatment adherence among gay, bisexual, and other men who have sex with men (gbMSM). Crystal meth use has been increasing among gbMSM in the Metropolitan Area of Mexico City (MAMC). Therefore, this study aimed to determine the association between HIV-related stigma and HIV treatment adherence among gbMSM who use crystal meth in the MAMC. This study was undertaken as part of an exploratory study of crystal meth use in the MAMC. The data were collected from September to December 2021 through an encrypted online survey. Participants (n = 89) were gbMSM adults living with HIV who reported crystal meth use in the past month that were recruited through an online snowball sampling. The online survey included questions about HIV treatment adherence, sexual behaviors, the Alcohol, Smoking, and Substance Involved Screening Test, and the HIV-Related Stigma Mechanisms Scale. Logistic regression analyses assessed the association between HIV-related stigma and HIV treatment adherence. The multivariate logistic regression model showed that, controlling for health insurance [adjusted odds ratio (AOR) = 0.13; 95% confidence intervals (CI)  = 0.02-0.59] and educational level (AOR = 0.16; 95% CI = 0.02-0.88), non-adherence to HIV treatment was independently associated with higher HIV-related stigma (AOR = 1.06; 95% CI = 1.01-1.12). Public health policies must include HIV-related stigma and substance use in treating gbMSM with HIV.

The impact of hope levels on treatment adherence in psychiatric patients.

PURPOSE: In this study, aimed to determine the status of hope and treatment adherence in psychiatric patients and the relationship between the two. MATERIAL AND METHOD: The sample of the study consisted of participants (n = 103) in a university hospital psychiatric clinic. Research data were collected using personal information form, Morisky treatment adherence scale and Herth Hope Index (HHI). Statistical analysis of the data was carried out with SPSS 22.0 program using descriptive tests, student t-test, one-way variance analysis, chi-square test and Spearman correlation analysis. RESULTS: The average score of the patients' hope scale is 34.23 ± 9.59 and is above the intermediate level. 43.7 % of patients have low adherence with treatment. It was found that as patients' hope scores increased (r = -0.417) non-adherence with treatment decreased; as annual hospitalization increased non-adherence increased (r = 0.274); as the duration of disease increased score of hope (r = -0.271), non-adherence with therapy (r = 0.353) and annual hospitalization increased (r = 0.211) (p < .05). Among the patients who took part in the study, 36.9 % were diagnosed with bipolar disorder, 33.0 % with schizophrenia and other psychotic disorders, 20.4 % with depression. Patients with bipolar disorder had higher treatment non-adherence scores. It was determined that 29.1 % of the patients stopped taking medication thinking they had recovered and 28.2 % did not adhere to the treatment due to drug side effects. CONCLUSION: The findings underscore the crucial role of hope in influencing treatment adherence among psychiatric patients. Clinicians should consider strategies to bolster hope as a potential avenue for improving adherence rates.

Inclusion of a computerized test in ADHD diagnosis process can improve trust in the specialists' decision and elevate adherence levels.

Attention deficit and hyperactivity disorder (ADHD) affects many life aspects of children and adults. Accurate identification, diagnosis and treatment of ADHD can facilitate better care. However, ADHD diagnosis and treatment methods are subject of controversy. Objective measures can elevate trust in specialist's decision and treatment adherence. In this observational study we asked whether knowing that a computerized test was included in ADHD diagnosis process results in more trust and intention to adhere with treatment recommendations. Questionnaires were administered to 459 people, 196 men, average age = 40.57 (8.90). Questions regarding expected trust and adherence, trust trait, trust in physician and health-care-institutions, and ADHD scales followed a scenario about parents referred to a neurologist for sons' ADHD diagnosis. The scenario presented to the test group (n = 185) mentioned that a computerized test was part of the diagnostic process. The control group scenario didn't mention any computerized test in the diagnostic process. Test group participants expressed more trust in the diagnosis and greater levels of intention for treatment adherence. Group differences in intention for treatment adherence were mediated by trust in decision. Inclusion of a computerized test in ADHD diagnosis process can improve trust in the specialists' decision and elevate adherence levels.

Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence.

BACKGROUND: Cloninger's psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient's temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger's personality dimensions and medication adherence among glaucoma patients. METHODS: The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS - German Clinical Trials Register; (DRKS-ID: DRKS00022081). RESULTS: According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). CONCLUSIONS: The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients' personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.

Optimal hepatitis C treatment adherence patterns and sustained virologic response among people who inject drugs: The HERO study.

BACKGROUND & AIMS: Direct-acting antivirals (DAAs) are highly effective for treating HCV infection even among people who inject drugs (PWID). Yet, little is known about patients' adherence patterns and their association with sustained virologic response (SVR) rates. We aimed to summarize various adherence patterns and determine their associations with SVR. METHODS: Electronic blister packs were used to measure daily adherence to once-a-day sofosbuvir/velpatasvir during the 12-week treatment period among active PWIDs. Blister pack data were available for 496 participants who initiated DAAs for whom SVR status was known. Adherence was summarized in multiple patterns, such as total adherent days, consecutive missed days, and early discontinuations. Thresholds for adherence patterns associated with >90% SVR rates were also determined. RESULTS: The overall SVR rate was 92.7%, with a median adherence rate of 75%. All adherence patterns indicating greater adherence were significantly associated with achieving SVR. Participant groups with ≥50% (>42/84) adherent days or <26 consecutive missed days achieved an SVR rate of >90%. Greater total adherent days during 9-12 weeks and no early discontinuation were significantly associated with higher SVR rates only in those with <50% adherence. Participants with first month discontinuation and ≥2 weeks of treatment interruption had low SVR rates, 25% and 85%, respectively. However, greater adherent days were significantly associated with SVR (adjusted odds ratio 1.10; 95% CI 1.04-1.16; p <0.001) even among participants with ≥14 consecutive missed days. CONCLUSIONS: High SVR rates can be achieved in the PWID population despite suboptimal adherence. Encouraging patients to take as much medication as possible, with <2 weeks consecutive missed days and without early discontinuation, was found to be important for achieving SVR. IMPACT AND IMPLICATIONS: People who inject drugs can be cured of HCV in >90% of cases, even with relatively low adherence to direct-acting antivirals, but early discontinuations and long treatment interruptions can significantly reduce the likelihood of achieving cure. Clinicians should encourage people who inject drugs who are living with HCV to adhere daily to direct-acting antivirals as consistently as possible, but if any days are interrupted, to continue and complete treatment. These results from the HERO study are important for patients living with HCV, clinicians, experts writing clinical guidelines, and payers. CLINICAL TRIAL NUMBER: NCT02824640.

Real-world evaluation of care for type 2 diabetes in Malaysia: A cross-sectional analysis of the treatment adherence to guideline evaluation in type 2 diabetes (TARGET-T2D) study.

AIM: Given a lack of data on diabetes care performance in Malaysia, we conducted a cross-sectional study to understand the clinical characteristics, control of cardiometabolic risk factors, and patterns of use of guideline-directed medical therapy (GDMT) among patients with type 2 diabetes (T2D), who were managed at publicly-funded hospitals between December 2021 and June 2022. METHODS: Patients aged ≥18 years with T2D from eight publicly-funded hospitals in the Greater Kuala Lumpur region, who had ≥2 outpatient visits within the preceding year and irrespective of treatment regimen, were eligible. The primary outcome was ≥2 treatment target attainment (defined as either HbA1c <7.0%, blood pressure [BP] <130/80 mmHg, or low-density lipoprotein cholesterol [LDL-C] <1.8 mmol/L). The secondary outcomes were the individual treatment target, a combination of all three treatment targets, and patterns of GDMT use. To assess for potential heterogeneity of study findings, all outcomes were stratified according to prespecified baseline characteristics namely 1) history of atherosclerotic cardiovascular disease (ASCVD; yes/no) and 2) clinic type (Diabetes specialist versus General medicine). RESULTS: Among 5094 patients (mean±SD age 59.0±13.2 years; T2D duration 14.8±9.2 years; HbA1c 8.2±1.9% (66±21 mmol/mol); BMI 29.6±6.2 kg/m2; 45.6% men), 99% were at high/very high cardiorenal risk. Attainment of ≥2 treatment targets was at 18%, being higher in General medicine than in Diabetes specialist clinics (20.8% versus 17.5%; p = 0.039). The overall statin coverage was 90%. More patients with prior ASCVD attained LDL-C <1.4 mmol/L than those without (13.5% versus 8.4%; p<0.001). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (13.2% versus 43.2%), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (1.0% versus 6.2%), and insulin (27.7% versus 58.1%) were lower in General medicine than in Diabetes specialist clinics. CONCLUSIONS: Among high-risk patients with T2D, treatment target attainment and use of GDMT were suboptimal.

The Use of mHealth in Promoting Therapeutic Adherence: A Scoping Review.

Nonadherence to therapy negatively impacts mortality and quality of life and results in suboptimal efficacy of treatment regimens, threats to patient safety, and increased healthcare costs for disease management. Mobile health solutions can offer users instruments that can promote therapeutic adherence. The objective of this review is to investigate the impact mobile health systems have on therapeutic adherence. Specifically, we want to map the main systems used, the functions implemented, and the different methods of adherence detection used. For this purpose, a scoping review was conducted. The following databases were consulted: PubMed, Cochrane Library, EBSCO (including APA PsycINFO, CINAHL Plus with Full Text, ERIC), including English-language studies published in the last 10 years (2012-2022). The main mobile health systems used are as follows: applications, automated messaging, interactive voice response, and mobile video games. The main features implemented to support medication management were as follows: reminders, self-monitoring instruments, educational support, and caregiver involvement. In conclusion, the use of interactive mobile health instruments intended for use by the patient and/or caregiver can improve objectively and subjectively detected therapeutic adherence. The use of these systems in the therapeutic pathway of users, with a special focus on people with comorbidities and in polypharmacy treatment, represents a challenge to improve caregiver health.

A Novel Digital Educational Strategy Improves Treatment Adherence and Quality of Life in Patients with Multiple Myeloma.

Multiple myeloma, the second most common hematologic malignancy worldwide, is an aggressive disease with high morbidity and mortality rates. Although myeloma remains incurable, new treatments have improved patients' life expectancy and quality of life. However, as these therapies are administered for prolonged and often indefinite periods, their success depends on high treatment adherence and significant patient engagement. This study aimed to evaluate the impact of a novel digital educational strategy on treatment adherence, quality of life, and the development of complications in patients with newly diagnosed myeloma. To this end, a two-arm, randomized, prospective, double-blind study was conducted to compare the conventional educational approach alone or combined with the novel digital strategy. This strategy was based on some principles of the Persuasive Systems Design model and incorporated the educational recommendations of patients and caregivers. Compared to the control group that only received information through the conventional educational approach, patients randomized to the digital strategy showed significantly higher treatment adherence and quality of life, associated with increased functionality and rapid reincorporation into daily routines. The digital strategy empowered patients and caregivers to understand the disease and therapeutic options and helped patients recall treatment information and implement healthy lifestyle habits. These results support that patient-targeted educational strategies can positively influence treatment adherence and thus improve their quality of life.

The predictive role of intimate partner violence in treatment adherence among women with chronic illness: A cross-sectional study.

OBJECTIVE: This study was an attempt to shed light on the predictive role of intimate partner violence in adhering to treatment regimens in women with chronic illnesses. METHOD: In a descriptive-analytical study, 400women with chronic illnesses in Bushehr were selected through convenience sampling. The data were collected by distributing a demographic information form and two questionnaires, including the intimate partner violence (IPV) questionnaire and the treatment adherence scale. RESULTS: According to the results, the 40 to 59 years age group (P = 0.046, ß = 0.104), the 60 to 79 years age group (P = 0.019, ß = 0.122), and the group receiving education about chronic illness (P = 0.031, ß = 0.106) showed a direct relationship with treatment adherence, while IPV (P < 0.001, ß = 0.284) had a significant inverse relationship with treatment adherence. CONCLUSION: The results of the study showed that predictors of treatment adherence are IPV in women aged 40 and older with chronic illnesses, and receiving education about chronic illnesses. It is necessary for healthcare providers to consider barriers such as intimate partner violence when providing education in order to increase treatment adherence. To avoid nonadherence, managers and health planners should implement policies to increase the level of awareness of healthcare staff on how to manage care of women with chronic illnesses who are abused by an intimate partner and refer them to counselors and family helpers.

Estratégias educativas em saúde para pessoas vivendo com HIV: revisão de escopo / Estrategias educativas en salud para personas que viven con el VIH: revisión de alcance / Health educational strategies for people living with HIV: scoping review

Resumo Objetivo Mapear a produção científica sobre as estratégias educativas e os conteúdos abordados na educação de pessoas vivendo com HIV. Métodos Esta é uma revisão de escopo em que a seleção dos artigos foi realizada em abril de 2021 e atualizada em outubro de 2022 em dez fontes de dados; a revisão seguiu os pressupostos estabelecidos pelo Joanna Briggs Institute e o checklist dos Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Os resultados foram analisados descritivamente e sintetizados em um quadro. Resultados Foram selecionados 17 estudos com publicação predominante em 2017; Estados Unidos da América e Brasil foram os países com a maior quantidade de produções. A maioria dos estudos buscou avaliar o impacto e a eficácia das estratégias e desenvolver ou validar instrumentos de educação em saúde e atividades de prevenção. Em relação ao conteúdo abordado pelas estratégias, foram formadas cinco categorias: orientação inicial sobre HIV/AIDS, cuidados gerais, vida saudável, saúde sexual e suporte emocional. As estratégias educativas que se destacaram em relação à maior adesão dos pacientes ao tratamento estão relacionadas com o desenvolvimento de sistemas, programas e multimídia. As cartilhas promoveram empoderamento e autonomia de pessoas vivendo com HIV. Conclusão Foram mapeadas as principais estratégias educativas, com destaque para cartilhas, material impresso, recursos multimídia, sistemas, formulários e oficinas/workshops, abordando orientação inicial sobre HIV/AIDS, tratamento farmacológico, cuidados gerais, vida saudável, saúde sexual e suportes social e emocional.

Resumen Objetivo Mapear la producción científica sobre las estrategias educativas y los contenidos abordados en la educación de personas que viven con el VIH. Métodos Esta es una revisión de alcance, cuya selección de artículos se realizó en abril de 2021 y se actualizó en octubre de 2022 en diez fuentes de datos. La revisión siguió las premisas establecidas por el Joanna Briggs Institute y la checklist de los Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Los resultados fueron analizados descriptivamente y sintetizados en un cuadro. Resultados Se seleccionaron 17 estudios con publicación predominante en 2017. Estados Unidos de América y Brasil fueron los países con mayor cantidad de producciones. La mayoría de los estudios buscó evaluar el impacto y la eficacia de las estrategias y elaborar o validar instrumentos de educación para la salud y actividades de prevención. Con relación al contenido abordado por las estrategias, se formaron cinco categorías: instrucciones iniciales sobre VIH/SIDA, cuidados generales, vida saludable, salud sexual y apoyo emocional. Las estrategias educativas que se destacaron con relación a una mayor adhesión de los pacientes al tratamiento están relacionadas con el desarrollo de sistemas, programas y multimedia. Las cartillas promovieron empoderamiento y autonomía de personas que viven con el VIH. Conclusión Se mapearon las principales estrategias educativas, con énfasis en cartillas, material impreso, recursos multimedia, sistemas, formularios y talleres/workshops, que abordaron instrucciones iniciales sobre VIH/SIDA, tratamiento farmacológico, cuidados generales, vida saludable, salud sexual y apoyo social y emocional. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Abstract Objective To map the scientific production on educational strategies and the content covered in the education of people living with HIV. Methods This is a scoping review in which the selection of articles was carried out in April 2021 and updated in October 2022 in ten data sources; the review followed the assumptions established by the Joanna Briggs Institute and the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The results were descriptively analyzed and summarized in a chart. Results A total of 17 studies were selected, predominantly published in 2017; The USA and Brazil were the countries with the largest number of productions. Most studies sought to evaluate the impact and effectiveness of strategies and develop or validate health education instruments and prevention activities. Concerning the content covered by the strategies, five categories were formed: initial guidance on HIV/AIDS, general care, healthy living, sexual health, and emotional support. The educational strategies that stood out concerning greater patient adherence to treatment are related to the development of systems, programs, and multimedia. The booklets promoted empowerment and autonomy for people living with HIV. Conclusion The main educational strategies were mapped, with emphasis on booklets, printed material, multimedia resources, systems, forms, and workshops, covering initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

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.

Womandla Health: development and rationale of a behavioral intervention to support HIV treatment adherence among postpartum women in South Africa.

BACKGROUND: While Option B + has made great strides in eliminating vertical transmission of HIV and improving access to lifelong antiretroviral therapy (ART) for women, the postpartum period remains a risk period for disengagement from HIV care and non-adherence. METHODS: Longitudinal qualitative data was collected from 30 women living with HIV in Cape Town, South Africa from pregnancy through 1 year postpartum to examine key barriers and facilitators to HIV treatment adherence across this transition. Participants were also asked about their preferences for behavioral intervention content, format, and scope. The intervention development process was guided by Fernandez et al.'s Intervention Mapping process and was informed by the qualitative data, the wider literature on ART adherence, and Transition Theory. RESULTS: The Womandla Health Intervention is a multicomponent intervention consisting of four individual sessions with a lay health worker and four peer group sessions, which span late pregnancy and early postpartum. These sessions are guided by Transition Theory and utilize motivational interviewing techniques to empower women to ascertain their own individual barriers to HIV care and identify solutions and strategies to overcome these barriers. CONCLUSIONS: This intervention will be tested in a small scale RCT. If successful, findings will provide an innovative approach to HIV treatment by capitalizing on the transition into motherhood to bolster self-care behaviors, focusing on ART adherence and also women's overall postpartum health and psychosocial needs.

Analysis of treatment adherence in patients undergoing phototherapy.

OBJECTIVE: Phototherapy is a convenient and effective treatment alternative for a range of skin diseases. However, a major challenge in patient adherence to phototherapy may be the necessity of visiting a phototherapy center regularly over an extended period of time. The aims of this study were (i) to investigate the adherence rate to phototherapy and (ii) to determine factors associated with adherence to narrow-band ultraviolet B phototherapy (nbUVB) treatment. PATIENTS AND METHODS: A retrospective review of patient records who underwent nbUVB phototherapy between January 1, 2018, and March 31, 2023, was performed. Patient records were reviewed for age, gender, skin type, diagnosis, type of phototherapy applied, duration of treatment, total number of sessions, presence of side effects, reasons for discontinuation of treatment, and perceived benefits of treatment. RESULTS: Of a total of 729 patients undergoing phototherapy, 281 (38.5%) discontinued treatment before completing 20 sessions. In particular, younger patients and those who experienced fewer side effects tended to discontinue treatment prematurely. The most common reason for discontinuing treatment was difficulty in visiting the hospital regularly. CONCLUSIONS: The patient's compliance with phototherapy was 61.5%. These results indicate that phototherapy is still one of the preferred treatment methods, although many new treatment agents have been developed in dermatology in recent years. Identifying and addressing factors that affect patient adherence will certainly help increase the effectiveness of treatment.

Qualitative study of COVID-19 patient experiences with non-invasive ventilation and pronation: strategies to enhance treatment adherence.

INTRODUCTION: Non-invasive ventilation (NIV) treatment combined with pronation in patients with COVID-19 respiratory failure has been shown to be effective in improving respiratory function and better patient outcomes. These patients may experience discomfort or anxiety that may reduce adherence to treatment. OBJECTIVE: The aim of this study was to explore and describe the subjective experiences of patients undergoing helmet NIV and pronation during hospitalisation for COVID-19 respiratory failure, with a focus on the elements of care and strategies adopted by patients that enabled good adaptation to treatments. METHOD: A qualitative descriptive study, using face-to-face interviews, was carried out with a purposeful sample of 20 participants discharged from a pulmonary intensive care unit who underwent helmet continuous positive airway pressure and pronation during hospitalisation for COVID-19. RESULTS: Content analysis of the transcripts revealed feelings and experiences related to illness and treatments, strategies for managing one's own negative thoughts, and practical strategies of one's own and healthcare workers to facilitate adaptation to pronation and helmet. Experience was reflected in five major topics related to specific time points and settings: feelings and experiences, helmet and pronation: heavy but beneficial, positive thinking strategies, patients' practical strategies, support of healthcare professionals (HCPs). CONCLUSIONS: This study may be useful to HCPs to improve the quality and appropriateness of care they provide.

Determinants of option B+ HIV treatment adherence among HIV-positive breastfeeding women in Zimbabwe.

Zimbabwe is one of the countries in sub-Saharan Africa with the highest prevalence of HIV. Despite the launch of the Option B+ treatment approach in 2013 to eliminate mother-to-child transmission, the number of pregnant women and children living with HIV is still high due to non-adherence. This prompted this study with the aim to explore the determinants of adherence to Option B+ HIV treatment among HIV-positive breastfeeding women. This descriptive phenomenological study explored the lived experiences of 12 purposively recruited HIV-positive breastfeeding women in 2020 through in-depth interviews. The collected data were analysed using Colaizzi's phenomenological data analysis framework. The study findings revealed that client-related factors such as food insecurity, travel, early infant diagnosis, and treatment-related factors such as the unavailability of drugs, the side effects of medications, and health institution-related factors are barriers to adherence among HIV-positive breastfeeding women. The findings also indicated that support from the family, health care workers, awareness of the benefits of the treatment plan, and positive role models are promoters of adherence. To improve breastfeeding women's adherence to Option B+ HIV treatment, the identified barriers to adherence should be addressed while optimising the motivators of adherence.

Le Zimbabwe est l'un des pays d'Afrique subsaharienne où la prévalence du VIH est la plus élevée. Malgré le lancement de l'approche thérapeutique Option B+ en 2013 pour éliminer la transmission mère-enfant, le nombre de femmes enceintes et d'enfants vivant avec le VIH reste élevé en raison de la non-observance. Cela a incité cette étude dans le but d'explorer les déterminants de l'observance du traitement anti-VIH Option B+ chez les femmes séropositives qui allaitent. Cette étude phénoménologique descriptive a exploré les expériences vécues de 12 femmes allaitantes séropositives recrutées à dessein en 2020 au moyen d'entretiens approfondis. Les données collectées ont été analysées à l'aide du cadre d'analyse de données phénoménologiques de Colaizzi. Les résultats de l'étude ont révélé que des facteurs liés aux clients, tels que l'insécurité alimentaire, les voyages, le diagnostic précoce du nourrisson et des facteurs liés au traitement, tels que l'indisponibilité des médicaments, les effets secondaires des médicaments et les facteurs liés aux établissements de santé, constituent des obstacles à l'observance chez les personnes infectées par le VIH. -les femmes qui allaitent positivement. Les résultats ont également indiqué que le soutien de la famille, des agents de santé, la conscience des avantages du plan de traitement et des modèles positifs sont des facteurs favorisant l'observance. Pour améliorer l'observance des femmes qui allaitent au traitement du VIH Option B+, les obstacles identifiés à l'observance doivent être surmontés tout en optimisant les facteurs de motivation de l'observance.

Atención farmacéutica en pacientes con inmunodeficiencia adquirida y/o tuberculosis en el área ambulatoria de un hospital pediátrico / Pharmacovigilance in patients with acquired immunodeficiency and/or tuberculosis in the outpatient area of a pediatric hospital

La Atención farmacéutica (AF) ayuda a los pacientes a alcanzar objetivos terapéuticos reduciendo los problemas relacionados al medicamento (PRM). Objetivos: analizar los PRM en la práctica de la AF a pacientes con inmunodeficiencia adquirida (IDA) y/o tuberculosis (TBC) y evaluar su impacto. Método: estudio, descriptivo, observacional, en el área ambulatoria de Farmacia. Se incluyeron pacientes con IDA y/o TBC con: inicio de tratamiento, polifarmacia, reinternaciones frecuentes, regular/mala adherencia, reacciones adversas a medicamentos (RAM) previas y/o comorbilidades. Se entrevistaron pacientes o cuidadores y se registraron PRM, errores, grados de adherencia y conocimiento farmacoterapéutico, retiro oportuno de medicamentos y parámetros clínicos. Se registró la intervención farmacéutica y entregó material educativo. Se repitieron las mediciones en una segunda entrevista. Resultados: Se estudiaron 54 pacientes (28 con IDA y 26 con TBC). Se realizaron 93 intervenciones (29.9% dirigidas al prescriptor, 27.8% a otros profesionales) y se detectaron 8 RAM y 53 errores (28 IDA y 25 TBC), el principal PRM fue la mala/regular adherencia con bajo porcentaje de conocimiento farmacoterapéutico completo. Después de la AF, en IDA el grado de adherencia tuvo una mejora estadísticamente significativa (p= 0.012), también fue significativa la mejora en el retiro oportuno de la medicación (28.6% a 71.4% p=0.005 IDA). Se obtuvieron resultados favorables de carga viral (CV) en 72% pacientes con IDA y aumento de peso en 92% pacientes con TBC, aunque no fueron estadísticamente significativos. Conclusiones: mediante AF se mejoró la adherencia y la comunicación en pacientes pediátricos con IDA y/o TBC (AU)

Pharmacovigilance (PV) helps patients achieve therapeutic goals by reducing drug-related problems (DRP). Objectives: to analyze DRPs in the practice of PV in patients with acquired immunodeficiency (AIDS) and/or tuberculosis (TB) and to evaluate its impact. Methods: A descriptive, observational study was conducted in the outpatient pharmacy area. Patients with AIDS and/or TB with: treatment initiation, polypharmacy, frequent readmissions, regular/poor adherence, previous adverse drug reactions (ADR) and/or comorbidities were included. Patients or caregivers were interviewed, and DRP, errors, adherence and pharmacotherapeutic knowledge, timely drug withdrawal, and clinical parameters were recorded. The pharmaceutical intervention was recorded and educational material was delivered. Measurements were repeated in a second interview. Results: We studied 54 patients (28 with AIDS and 26 with TB). Ninety-three interventions were performed (29.9% addressed to the drug prescriber, 27.8% to other professionals) and 8 ADRs and 53 errors were detected (28 AIDS and 25 TB). The main DRP was poor/regular adherence together with a low level of complete pharmacotherapeutic knowledge. After PV, in patients with AIDS the degree of adherence statistically significantly improved (p= 0.012). The improvement in timely medication withdrawal was also significant (28.6% vs. 71.4% p=0.005 AID). Favorable viral load results were obtained in 72% of patients with AIDS and weight gain in 92% of patients with TB, although they were not statistically significant. Conclusions: PV improved adherence and communication in pediatric patients with AIDS and/or TB (AU)

Factors associated with pharmacological treatment in children with attention-deficit/hyperactivity disorders: a retrospective study of a series of 77 cases in a single third-level reference Centre in Apulia region.

BACKGROUND: The present study analysed data on children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) who were referred to the ADHD reference centre of Scientific Institute IRCCS E. Medea (Brindisi, Italy) for ADHD pharmacotherapy initiation and monitoring overtime. The main aim of the study was to examine differences in pharmacological treatment status (i.e., treatment continuation vs discontinuation) between patients. METHODS: Seventy-seven children and adolescents (mean age at pharmacotherapy initiation = 9.5, standard deviation = 2.6) with ADHD received drugs treatment for ADHD at the reference center between January, 2013 and May, 2022. Demographic and clinical data were obtained from the Italian Registry for ADHD and medical records. Child Behavior Checklist (CBCL) available data were used. RESULTS: Pharmacological treatment status was examined for patients (n = 63) with at least 12 months of follow-up after the first pharmacological treatment for ADHD. After starting pharmacotherapy treatment, 77.8% (n = 49) patients were still on treatment whereas 22.2% (n = 14) discontinued it. No between group difference were observed in demographic and clinical data except for the intelligence quotient/intellectual disability and rule-breaking behavior (n = 40). CONCLUSIONS: This study stressed the need of periodical assessments, monitoring difficulties with treatment and/or reasons for poor treatment compliance to provide individualized care.

Mental and Emotional Health of Caregivers of Youth with Sickle Cell Disease: A Systematic Review.

People of African descent and those identifying as Black and/or Latino experience a disproportionate burden of sickle cell disease (SCD), a chronic, serious blood condition. Caregivers of children with chronic medical conditions report worse mental health than others. Disease-associated stressors can affect caregivers of children with SCD. We conducted a systematic review to summarize the prevalence of mental health symptoms in caregivers of children with SCD and to see if symptoms were associated with the child's SCD. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, PsycINFO, and Embase, identifying 1,322 records of which 40 met criteria for inclusion in this review. Findings suggest caregivers experience mental health problems, and poorer mental health was associated with worse child SCD-related outcomes and treatment adherence. Efforts should be made to routinely screen SCD caregiver mental health and to refer accordingly.