HIGH PREVALENCE OF NON-ADHERENCE TO ULCERATIVE COLITIS THERAPY IN REMISSION: KNOWING THE PROBLEM TO PREVENT LOSS.

BACKGROUND: Ulcerative colitis (UC) is a chronic inflammatory disease whose manifestations can drastically affect the individual's quality of life, and therefore adherence to treatment is important in order to keep it in remission. OBJECTIVE: To verify the prevalence of non-adherence and the influence of sociodemographic, clinical and pharmacotherapeutic characteristics associated with non-adherence to treatment of UC in remission. METHODS: Cross-sectional study conducted with 90 individuals diagnosed with UC in remission. The information was collected through interviews during medical consultations at Medical Clinic of Gastroenterology of Hospital Universitário da Universidade Federal de Juiz de Fora. To verify the association of the variables under study with the outcome of interest and its measure of association, Student's t-test or Pearson's chi-square non-parametric test (P<0.05) was used and prevalence ratio and confidence interval were calculated. RESULTS: A high prevalence of non-adherence (77.8%) was found among patients with UC in remission. The individuals most likely to not adhere to the treatment were those aged less than 50 years, who were not engaged in paid work, with high scores for anxiety and who used more than one medication as part of the treatment of UC. CONCLUSION: These findings reinforce that acknowledging the factors that influence the non-adherence behavior is of paramount importance for the development of strategies by health care professionals, assuring that those will be really effective to prolong, as much as possible, one of the most successful ways to maintain the UC remission period: the use of medications.

Elevada prevalência de não adesão ao tratamento da colite ulcerativa em remissão: conhecer o problema para prevenir o prejuízo / High prevalence of non-adherence to ulcerative colitis therapy in remission: knowing the problem to prevent loss

ABSTRACT Background Ulcerative colitis (UC) is a chronic inflammatory disease whose manifestations can drastically affect the individual's quality of life, and therefore adherence to treatment is important in order to keep it in remission. Objective To verify the prevalence of non-adherence and the influence of sociodemographic, clinical and pharmacotherapeutic characteristics associated with non-adherence to treatment of UC in remission. Methods Cross-sectional study conducted with 90 individuals diagnosed with UC in remission. The information was collected through interviews during medical consultations at Medical Clinic of Gastroenterology of Hospital Universitário da Universidade Federal de Juiz de Fora. To verify the association of the variables under study with the outcome of interest and its measure of association, Student's t-test or Pearson's chi-square non-parametric test (P<0.05) was used and prevalence ratio and confidence interval were calculated. Results A high prevalence of non-adherence (77.8%) was found among patients with UC in remission. The individuals most likely to not adhere to the treatment were those aged less than 50 years, who were not engaged in paid work, with high scores for anxiety and who used more than one medication as part of the treatment of UC. Conclusion These findings reinforce that acknowledging the factors that influence the non-adherence behavior is of paramount importance for the development of strategies by health care professionals, assuring that those will be really effective to prolong, as much as possible, one of the most successful ways to maintain the UC remission period: the use of medications.

RESUMO Contexto Colite ulcerativa é uma doença inflamatória crônica que pode apresentar manifestações graves que afetam drasticamente a qualidade de vida do indivíduo e, dessa maneira, a adesão ao tratamento é importante a fim de manter a doença em remissão. Objetivo Verificar a prevalência de não adesão e a influência de características sociodemográficas, clínicas e farmacoterapêuticas associadas a não adesão ao tratamento da colite ulcerativa em remissão. Métodos Estudo transversal envolvendo 90 indivíduos diagnosticados com colite ulcerativa em remissão. As entrevistas foram conduzidas durante as consultas médicas realizadas na Clínica Médica de Gastroenterologia do Hospital Universitário da Universidade Federal de Juiz de Fora. Para verificar a associação entre as variáveis com o desfecho de interesse, foi aplicado teste-t de Student ou teste não-paramétrico qui-quadrado de Pearson (P<0,05) e também razão de prevelência e intervalos de confiança foram calculados. Resultados Uma elevada prevalência de não adesão (77,8%) foi encontrada dentre os pacientes com colite ulcerativa em remissão. Os indivíduos mais propensos ao comportamento em questão foram aqueles com menos de 50 anos, sem trabalho remumerado, com escores mais elevados no teste de ansiedade e que utilizavam mais de um medicamento para o tratamento da colite ulcerativa. Conclusão Estes achados reforçam que o conhecimento de fatores que influenciam o comportamento de não adesão é de grande importância para o desenvolvimento de estratégias para a equipe de saúde, garantindo que estas sejam realmente eficazes para prolongar, tanto quanto possível, uma das formas mais bem-sucedidas de manter o período de remissão da colite ulcerativa: o uso de medicamentos.

Avaliação de danos cardiovasculares segundo framingham entre tabagistas internados numa instituição particular / Evaluation according to framingham of cardiovascular damages among smoker patients of a private institution

Pesquisa tipo survey que analisou a vulnerabilidade de fumantes internados numa instituição particular para eventos cardiovasculares. Consultamos prontuários e 125 participantes preencheram impresso entre outubro edezembro de 2004, dos quais 44% eram fumantes passivos, 39,2% não eram fumantes, 13,6% eram fumantesativos e 3,2%, fumantes ativos e passivos. Entre os abstêmios, categorizados segundo a classificação deProchaska e DiClemente, 48,8% estavam em manutenção, 41,5% em contemplação e 9,7% não pretendiammudar hábitos. Entre 21 fumantes, 71,4% consumiam dez a 30 cigarros/dia; a tragada foi de média a profunda entre 76,2%; a dependência foi de média a muito alta entre 42,8%, e a exposição passiva ao tabaco deu-se nafaixa etária de 01 a 30 anos para 74,5% dos participantes. O risco de eventos cardiovasculares ficou assimcaracterizado: 60% tinham baixo risco; 15,5%, médio risco; 19%, alto risco; e 5,5% não responderam a todas asquestões. Sendo o tabagismo um dos fatores de vulnerabilidade para morbimortalidades cardiovasculares, ações que promovam sua interrupção são relevantes.

This survey type research aimed at analyzing the vulnerability of active/passive smokers of a private institution. Medical records were analyzed, and a total of 125 (100%) individuals filled out forms from October to December 2004. Among them 39.2% stated not to have contact with smokers; 13.6% were active smokers and 3.2% were active/passive smokers. Among 41 abstemious-smoker participants, according to Prochaska and DiClementetaxonomy 48.8% were in maintenance; 41.5% in contemplation and 9.7% did not intend to change habits. Amongst 21 smokers, 71.4% smoked 10 to 30 cigarettes a day and their smoke intake ranged from medium to high, in a percentage of 76.2%. Tobacco addiction ranged from average to high for 42.8% of them, and the passive exposition to tobacco ranged from 1 to 30 years for 74.5% of the participants. The risk of coronary events amongst 104 participants was low for 60%, high for 19% and medium for 15.5%. Taking into consideration that smoking is a high-risk factor for cardiovascular disease; the results ha shown the necessity of its interruption as a means of reducing risk of death.