ABSTRACT
Se han reportado bajas tasas de adherencia al tratamiento de enfermedades crónicas (50 por ciento). Asimismo, los factores psicosociales estarían relacionados con la adherencia al tratamiento. Con el propósito de identificar la relación que existe entre factores psicosociales y la adherencia al tratamiento de la DM2 en usuarios del sistema de salud pública chileno, se diseñó un estudio no experimental transversal correlacional (n = 50, edad promedio 60,76 años). Se autoadministraron encuestas para evaluar estrés y estilo de afrontamiento, sintomatología depresiva, percepción de apoyo social y adherencia al tratamiento. 40 por ciento de los pacientes presenta valores de hemoglobina glicosilada (Hb1Ac) mayores a 9 por ciento, mientras que un 66 por ciento de los participantes presenta desde moderados a altos niveles de estrés. En promedio durante los últimos 7 días los participantes han cumplido con la dieta general en 4,37 días, han consumido frutas y verduras en 3,14 días y han realizado exámenes de glicemia en 1,1 días. Existe una correlación directa entre el estrés y la hemoglobina glicosilada. El apoyo social y la sintomatología depresiva no se asociaron con la adherencia al tratamiento pero sí con el estrés. Se confirman pobres cifras de adherencia, y la asociación entre alto estrés y altos índices de Hb1Ac.
It is estimated that rates of non-adherence to chronic diseases are around 50 percent. International studies have reported some psychosocial factors related to treatment adherence. The purpose of the present study was to detect the relationship between psychosocial factors and treatment adherence in a sample of Type 2 Diabetics subjects from a public health institution. To this end, a non - experimental transversal correlational study was designed with a 50 DM2 subjects sample, which average age was 60,76 years old. Self-report measures of stress level, coping style, depressive symptoms, social support perception and treatment adherence, were obtained. The results revealed that 40 percent of participants had glycosylated hemoglobin over 9 percent, and 66 percent of them shown moderate to high stress levels. In average during the last 7 days, the participants have accomplished the diet 4,37 days, consumed fruits and vegetables 3,14 days and took glycemia test in 1,1 days. There is a direct correlation between the stress level and concentrations of glycosylated hemoglobin. Unlike stress, social support and depressive symptomatology was not associated with treatment adherence. These results confirm low levels of treatment adherence and high rates of stress in DM2 patients, as well as its association with high levels of glycosylated hemoglobin.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Patient Compliance/psychology , /psychology , /therapy , Attitude to Health , Social Support , Depression , Stress, Psychological , Cross-Sectional Studies , Interpersonal RelationsABSTRACT
Background: Cortisol has been implicated in hypertension and lately reported to be regulated at the pre-receptor level by the 11ßHSD1 enzyme, which converts cortisone (E) to cortisol (F). Over expression ofthis enzyme in adipose tissue could determine an increase in available cortisol that interacts with the mineralocorticoid receptor (MR) in renal, brain and heart tissue, leading to similar hypertensive effects as in 11ßHSD2 impaired patients. Severa! polymorphisms have been reported in HSDl IB 1 gene (CAI5, CAI9 and InsA83557), which could modify HSDl IB 1 gene expression or activity. Aun: To determine the distribution and prevalence of CAI5, CAI9 and InsA83557 in the HSDl IBl gene, and to correlate these results with biochemical parameters in cortisol/ ACTH (HPA) and renin-angiotensin-aldosterone (RAA) axis in patients with essential hypertension (EH). Patients and Methods: We studied 113 EHpatients (76 non-obese and 37 obese, with a body mass índex >30 kg/m²) and 30 normotensive adults (NT). In each patient, we measured serum levéis of E E, serum aldosterone (SA), plasma renin activity (PRA), adrenocorticotrophic hormone (ACTH), the urinary free cortisol/creatinine (UFF/Cr), F/ACTH and SA/PRA ratios. Each polymorphism was studied by PCR and 8 percent polyacrylamide gel electrophoresis. Statistical associations were evaluated by Pearson correlations and the genetic equilibñum by the Hardy-Weinberg (H-W) equation. Results: We found all three polymorphisms in the EH and the NT group, both in genetic equilibñum. In obese essential hypertensives, the CAI5polymorphism showed association with SA/PRA ratio (r =0.189, p =0.012) and F/ACTH (r =0.301, p 0.048); CA19 also showed correlation with F/ACTH in obese EH (r = 0.220, p 0.009). The InsA83557polymorphism correlated with UFF/Cr in both EH (r =0.206; p =0.03), and in obese EH (r =0.354; p =0.05). Conclusions: The CAI5 and CAI9 polymorphism correlated with changes in biochemical parameters...